hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|GA,"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Effingham Health System,12/6/2024,2.0.0,Effingham Health System,"459 GA-119 Springfield, GA 31329",51236,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
SERVICE DESCRIPTION,CATEGORY,BILLING MSDRG | CPT | HCPCS,ITEM/SERVICE DESCRIPTION,BILLING REVENUE CODE,GROSS CHARGES,AETNA PLAN,AETNA REIMBURSEMENT METHOD,AETNA MEDICARE PLAN,AETNA MEDICARE REIMBURSEMENT METHOD,AMERIGROUP PLAN,AMERIGROUP REIMBURSEMENT METHOD,BCBS MEDICARE PLAN,BCBS MEDICARE REIMBURSEMENT METHOD,BCBS PPO PLAN,BCBS PPO REIMBURSEMENT METHOD,BEECHSTREET PLAN,BEECHSTREET REIMBURSEMENT METHOD,CARESOURCE PLAN,CARESOURCE REIMBURSEMENT METHOD,CIGNA PLAN,CIGNA REIMBURSEMENT METHOD,HUMANA PLAN,HUMANA REIMBURSEMENT METHOD,HUMANA MEDICARE PLAN,HUMANA MEDICARE REIMBURSEMENT METHOD,MEDICAID PLAN,MEDICAID REIMBURSEMENT METHOD,MEDICARE PLAN,MEDICARE REIMBURSEMENT METHOD,MULTIPLAN PHCS PLAN,MULTIPLAN PHCS REIMBURSEMENT METHOD,PEACHSTATE PLAN,PEACHSTATE REIMBURSEMENT METHOD,THE CARE NETWORK PLAN,THE CARE NETWORK REIMBURSEMENT METHOD,UHC PLAN,UHC REIMBURSEMENT METHOD,UHC MEDICARE PLAN,UHC MEDICARE REIMBURSEMENT METHOD,UHC PPO PLAN,UHC PPO REIMBURSEMENT METHOD,WELLCARE PLAN,WELLCARE REIMBURSEMENT METHOD,De-Identified Minimum Negotiated Rate,De-Identified Maximum Negotiated Rate,DISCOUNTED CASH PRICE
Outpatient Medical Services,LAB,80307,ACETAMINOPHEN,301,$188.76 ,$126.47 ,67% of billed charges for outpatient setting,$52.85 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$61.16 ,100% GA Medicaid fee schedule for outpatient setting,$52.85 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$137.79 ,73% of billed charges for outpatient setting,$169.88 ,90% of billed charges for outpatient setting,$63.61 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$151.01 ,80% of billed charges for outpatient setting,$141.57 ,75% of billed charges for outpatient setting,$53.38 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$61.16 ,100% GA Medicaid fee schedule for outpatient setting,$52.85 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$179.32 ,95% of billed charges for outpatient setting,$62.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$160.45 ,85% of billed charges for outpatient setting,$113.26 ,60% of billed charges for outpatient setting,$52.85 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$113.26 ,60% of billed charges for outpatient setting,$62.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$52.85 ,$179.32 ,$122.69 
Outpatient Medical Services,LAB,82105,AFP TUMOR MARKER,301,$96.00 ,$64.32 ,67% of billed charges for outpatient setting,$26.88 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$21.10 ,100% GA Medicaid fee schedule for outpatient setting,$26.88 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$23.06 ,100% BCBS PPO fee schedule for outpatient setting,$86.40 ,90% of billed charges for outpatient setting,$21.94 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$76.80 ,80% of billed charges for outpatient setting,$72.00 ,75% of billed charges for outpatient setting,$27.15 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$21.10 ,100% GA Medicaid fee schedule for outpatient setting,$26.88 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$91.20 ,95% of billed charges for outpatient setting,$21.52 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$81.60 ,85% of billed charges for outpatient setting,$57.60 ,60% of billed charges for outpatient setting,$26.88 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$57.60 ,60% of billed charges for outpatient setting,$21.52 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$21.10 ,$91.20 ,$62.40 
Outpatient Medical Services,LAB,80320,ALCOHOL SERUM,301,$225.12 ,$150.83 ,67% of billed charges for outpatient setting,$63.03 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$13.59 ,100% GA Medicaid fee schedule for outpatient setting,$63.03 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$164.34 ,73% of billed charges for outpatient setting,$202.61 ,90% of billed charges for outpatient setting,$14.13 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$180.10 ,80% of billed charges for outpatient setting,$168.84 ,75% of billed charges for outpatient setting,$63.66 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$13.59 ,100% GA Medicaid fee schedule for outpatient setting,$63.03 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$213.86 ,95% of billed charges for outpatient setting,$13.86 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$191.35 ,85% of billed charges for outpatient setting,$135.07 ,60% of billed charges for outpatient setting,$63.03 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$135.07 ,60% of billed charges for outpatient setting,$13.86 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$13.59 ,$213.86 ,$146.33 
Outpatient Medical Services,LAB,86001,"ALLERGEN SPECIFIC IGG,EA ALLERGEN",302,$51.48 ,$34.49 ,67% of billed charges for outpatient setting,$14.41 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$6.57 ,100% GA Medicaid fee schedule for outpatient setting,$14.41 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$7.17 ,100% BCBS PPO fee schedule for outpatient setting,$46.33 ,90% of billed charges for outpatient setting,$6.83 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$41.18 ,80% of billed charges for outpatient setting,$38.61 ,75% of billed charges for outpatient setting,$14.56 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$6.57 ,100% GA Medicaid fee schedule for outpatient setting,$14.41 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$48.91 ,95% of billed charges for outpatient setting,$6.70 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$43.76 ,85% of billed charges for outpatient setting,$30.89 ,60% of billed charges for outpatient setting,$14.41 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$30.89 ,60% of billed charges for outpatient setting,$6.70 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$6.57 ,$48.91 ,$33.46 
Outpatient Medical Services,LAB,86003,"ALLERGEN, IGE, OTHER, EACH",302,$55.43 ,$37.14 ,67% of billed charges for outpatient setting,$15.52 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$6.57 ,100% GA Medicaid fee schedule for outpatient setting,$15.52 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$7.17 ,100% BCBS PPO fee schedule for outpatient setting,$49.89 ,90% of billed charges for outpatient setting,$6.83 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$44.34 ,80% of billed charges for outpatient setting,$41.57 ,75% of billed charges for outpatient setting,$15.68 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$6.57 ,100% GA Medicaid fee schedule for outpatient setting,$15.52 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$52.66 ,95% of billed charges for outpatient setting,$6.70 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$47.12 ,85% of billed charges for outpatient setting,$33.26 ,60% of billed charges for outpatient setting,$15.52 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$33.26 ,60% of billed charges for outpatient setting,$6.70 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$6.57 ,$52.66 ,$36.03 
Outpatient Medical Services,LAB,82103,ALPHA-1-ANTITRYPSIN,301,$203.53 ,$136.37 ,67% of billed charges for outpatient setting,$56.99 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.89 ,100% GA Medicaid fee schedule for outpatient setting,$56.99 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$18.47 ,100% BCBS PPO fee schedule for outpatient setting,$183.18 ,90% of billed charges for outpatient setting,$17.57 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$162.82 ,80% of billed charges for outpatient setting,$152.65 ,75% of billed charges for outpatient setting,$57.56 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$16.89 ,100% GA Medicaid fee schedule for outpatient setting,$56.99 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$193.35 ,95% of billed charges for outpatient setting,$17.23 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$173.00 ,85% of billed charges for outpatient setting,$122.12 ,60% of billed charges for outpatient setting,$56.99 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$122.12 ,60% of billed charges for outpatient setting,$17.23 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$16.89 ,$193.35 ,$132.29 
Outpatient Medical Services,LAB,82140,AMMONIA,301,$96.96 ,$64.96 ,67% of billed charges for outpatient setting,$27.15 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$12.44 ,100% GA Medicaid fee schedule for outpatient setting,$27.15 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$13.60 ,100% BCBS PPO fee schedule for outpatient setting,$87.26 ,90% of billed charges for outpatient setting,$12.94 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$77.57 ,80% of billed charges for outpatient setting,$72.72 ,75% of billed charges for outpatient setting,$27.42 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$12.44 ,100% GA Medicaid fee schedule for outpatient setting,$27.15 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$92.11 ,95% of billed charges for outpatient setting,$12.69 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$82.42 ,85% of billed charges for outpatient setting,$58.18 ,60% of billed charges for outpatient setting,$27.15 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$58.18 ,60% of billed charges for outpatient setting,$12.69 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$12.44 ,$92.11 ,$63.02 
Outpatient Medical Services,LAB,82150,AMYLASE,301,$139.32 ,$93.34 ,67% of billed charges for outpatient setting,$39.01 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$8.15 ,100% GA Medicaid fee schedule for outpatient setting,$39.01 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$8.91 ,100% BCBS PPO fee schedule for outpatient setting,$125.39 ,90% of billed charges for outpatient setting,$8.48 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$111.46 ,80% of billed charges for outpatient setting,$104.49 ,75% of billed charges for outpatient setting,$39.40 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$8.15 ,100% GA Medicaid fee schedule for outpatient setting,$39.01 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$132.35 ,95% of billed charges for outpatient setting,$8.31 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$118.42 ,85% of billed charges for outpatient setting,$83.59 ,60% of billed charges for outpatient setting,$39.01 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$83.59 ,60% of billed charges for outpatient setting,$8.31 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$8.15 ,$132.35 ,$90.56 
Outpatient Medical Services,LAB,86038,ANA,302,$164.45 ,$110.18 ,67% of billed charges for outpatient setting,$46.05 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$15.20 ,100% GA Medicaid fee schedule for outpatient setting,$46.05 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.62 ,100% BCBS PPO fee schedule for outpatient setting,$148.01 ,90% of billed charges for outpatient setting,$15.81 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$131.56 ,80% of billed charges for outpatient setting,$123.34 ,75% of billed charges for outpatient setting,$46.51 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$15.20 ,100% GA Medicaid fee schedule for outpatient setting,$46.05 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$156.23 ,95% of billed charges for outpatient setting,$15.50 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$139.78 ,85% of billed charges for outpatient setting,$98.67 ,60% of billed charges for outpatient setting,$46.05 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$98.67 ,60% of billed charges for outpatient setting,$15.50 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$15.20 ,$156.23 ,$106.89 
Outpatient Medical Services,LAB,86038,ANA IFA W/ REFLEX TO TITER AND PATTERN,302,$164.45 ,$110.18 ,67% of billed charges for outpatient setting,$46.05 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$15.20 ,100% GA Medicaid fee schedule for outpatient setting,$46.05 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.62 ,100% BCBS PPO fee schedule for outpatient setting,$148.01 ,90% of billed charges for outpatient setting,$15.81 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$131.56 ,80% of billed charges for outpatient setting,$123.34 ,75% of billed charges for outpatient setting,$46.51 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$15.20 ,100% GA Medicaid fee schedule for outpatient setting,$46.05 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$156.23 ,95% of billed charges for outpatient setting,$15.50 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$139.78 ,85% of billed charges for outpatient setting,$98.67 ,60% of billed charges for outpatient setting,$46.05 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$98.67 ,60% of billed charges for outpatient setting,$15.50 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$15.20 ,$156.23 ,$106.89 
Outpatient Medical Services,LAB,86255,ANTI SMOOTH MUSCLE AB,302,$240.06 ,$160.84 ,67% of billed charges for outpatient setting,$67.22 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$15.16 ,100% GA Medicaid fee schedule for outpatient setting,$67.22 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.57 ,100% BCBS PPO fee schedule for outpatient setting,$216.05 ,90% of billed charges for outpatient setting,$15.77 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$192.05 ,80% of billed charges for outpatient setting,$180.05 ,75% of billed charges for outpatient setting,$67.89 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$15.16 ,100% GA Medicaid fee schedule for outpatient setting,$67.22 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$228.06 ,95% of billed charges for outpatient setting,$15.46 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$204.05 ,85% of billed charges for outpatient setting,$144.04 ,60% of billed charges for outpatient setting,$67.22 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$144.04 ,60% of billed charges for outpatient setting,$15.46 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$15.16 ,$228.06 ,$156.04 
Outpatient Medical Services,LAB,86255,ANTIMITOCHONDRIAL AB,302,$240.06 ,$160.84 ,67% of billed charges for outpatient setting,$67.22 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$15.16 ,100% GA Medicaid fee schedule for outpatient setting,$67.22 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.57 ,100% BCBS PPO fee schedule for outpatient setting,$216.05 ,90% of billed charges for outpatient setting,$15.77 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$192.05 ,80% of billed charges for outpatient setting,$180.05 ,75% of billed charges for outpatient setting,$67.89 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$15.16 ,100% GA Medicaid fee schedule for outpatient setting,$67.22 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$228.06 ,95% of billed charges for outpatient setting,$15.46 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$204.05 ,85% of billed charges for outpatient setting,$144.04 ,60% of billed charges for outpatient setting,$67.22 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$144.04 ,60% of billed charges for outpatient setting,$15.46 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$15.16 ,$228.06 ,$156.04 
Outpatient Medical Services,LAB,82805,ARTERIAL BLOOD GASES W/CO-OX,301,$123.36 ,$82.65 ,67% of billed charges for outpatient setting,$34.54 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$35.69 ,100% GA Medicaid fee schedule for outpatient setting,$34.54 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$39.01 ,100% BCBS PPO fee schedule for outpatient setting,$111.02 ,90% of billed charges for outpatient setting,$37.12 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$98.69 ,80% of billed charges for outpatient setting,$92.52 ,75% of billed charges for outpatient setting,$34.89 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$35.69 ,100% GA Medicaid fee schedule for outpatient setting,$34.54 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$117.19 ,95% of billed charges for outpatient setting,$36.40 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$104.86 ,85% of billed charges for outpatient setting,$74.02 ,60% of billed charges for outpatient setting,$34.54 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$74.02 ,60% of billed charges for outpatient setting,$36.40 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$34.54 ,$117.19 ,$80.18 
Outpatient Medical Services,LAB,84450,AST,301,$27.84 ,$18.65 ,67% of billed charges for outpatient setting,$7.80 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$6.35 ,100% GA Medicaid fee schedule for outpatient setting,$7.80 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$7.11 ,100% BCBS PPO fee schedule for outpatient setting,$25.06 ,90% of billed charges for outpatient setting,$6.60 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$22.27 ,80% of billed charges for outpatient setting,$20.88 ,75% of billed charges for outpatient setting,$7.87 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$6.35 ,100% GA Medicaid fee schedule for outpatient setting,$7.80 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$26.45 ,95% of billed charges for outpatient setting,$6.48 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$23.66 ,85% of billed charges for outpatient setting,$16.70 ,60% of billed charges for outpatient setting,$7.80 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$16.70 ,60% of billed charges for outpatient setting,$6.48 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$6.35 ,$26.45 ,$18.10 
Outpatient Medical Services,LAB,87798,BACTERIAL VAGINOSIS,306,$137.00 ,$91.79 ,67% of billed charges for outpatient setting,$38.36 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$24.67 ,100% GA Medicaid fee schedule for outpatient setting,$38.36 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$26.97 ,100% BCBS PPO fee schedule for outpatient setting,$123.30 ,90% of billed charges for outpatient setting,$25.66 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$109.60 ,80% of billed charges for outpatient setting,$102.75 ,75% of billed charges for outpatient setting,$38.74 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$24.67 ,100% GA Medicaid fee schedule for outpatient setting,$38.36 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$130.15 ,95% of billed charges for outpatient setting,$25.16 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$116.45 ,85% of billed charges for outpatient setting,$82.20 ,60% of billed charges for outpatient setting,$38.36 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$82.20 ,60% of billed charges for outpatient setting,$25.16 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$24.67 ,$130.15 ,$89.05 
Outpatient Medical Services,LAB,80048,BASIC METABOLIC PANEL,301,$61.00 ,$40.87 ,67% of billed charges for outpatient setting,$17.08 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$10.65 ,100% GA Medicaid fee schedule for outpatient setting,$17.08 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$11.63 ,100% BCBS PPO fee schedule for outpatient setting,$54.90 ,90% of billed charges for outpatient setting,$11.08 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$48.80 ,80% of billed charges for outpatient setting,$45.75 ,75% of billed charges for outpatient setting,$17.25 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$10.65 ,100% GA Medicaid fee schedule for outpatient setting,$17.08 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$57.95 ,95% of billed charges for outpatient setting,$10.86 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$51.85 ,85% of billed charges for outpatient setting,$36.60 ,60% of billed charges for outpatient setting,$17.08 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$36.60 ,60% of billed charges for outpatient setting,$10.86 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$10.65 ,$57.95 ,$39.65 
Outpatient Medical Services,LAB,86900,BB ABO,302,$97.93 ,$65.61 ,67% of billed charges for outpatient setting,$27.42 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$3.75 ,100% GA Medicaid fee schedule for outpatient setting,$27.42 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$4.10 ,100% BCBS PPO fee schedule for outpatient setting,$88.14 ,90% of billed charges for outpatient setting,$3.90 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$78.34 ,80% of billed charges for outpatient setting,$73.45 ,75% of billed charges for outpatient setting,$27.69 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$3.75 ,100% GA Medicaid fee schedule for outpatient setting,$27.42 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$93.03 ,95% of billed charges for outpatient setting,$3.83 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$83.24 ,85% of billed charges for outpatient setting,$58.76 ,60% of billed charges for outpatient setting,$27.42 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$58.76 ,60% of billed charges for outpatient setting,$3.83 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$3.75 ,$93.03 ,$63.65 
Outpatient Medical Services,LAB,86870,BB ANTIBODY PANEL,302,$252.21 ,$168.98 ,67% of billed charges for outpatient setting,$70.62 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$6.12 ,100% GA Medicaid fee schedule for outpatient setting,$70.62 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$184.11 ,73% of billed charges for outpatient setting,$226.99 ,90% of billed charges for outpatient setting,$6.36 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$201.77 ,80% of billed charges for outpatient setting,$189.16 ,75% of billed charges for outpatient setting,$71.32 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$6.12 ,100% GA Medicaid fee schedule for outpatient setting,$70.62 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$239.60 ,95% of billed charges for outpatient setting,$6.24 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$214.38 ,85% of billed charges for outpatient setting,$151.33 ,60% of billed charges for outpatient setting,$70.62 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$151.33 ,60% of billed charges for outpatient setting,$6.24 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$6.12 ,$239.60 ,$163.94 
Outpatient Medical Services,LAB,86850,BB ANTIBODY SCREEN,302,$72.96 ,$48.88 ,67% of billed charges for outpatient setting,$20.43 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$15.23 ,100% GA Medicaid fee schedule for outpatient setting,$20.43 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$53.26 ,73% of billed charges for outpatient setting,$65.66 ,90% of billed charges for outpatient setting,$15.84 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$58.37 ,80% of billed charges for outpatient setting,$54.72 ,75% of billed charges for outpatient setting,$20.63 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$15.23 ,100% GA Medicaid fee schedule for outpatient setting,$20.43 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$69.31 ,95% of billed charges for outpatient setting,$15.53 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$62.02 ,85% of billed charges for outpatient setting,$43.78 ,60% of billed charges for outpatient setting,$20.43 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$43.78 ,60% of billed charges for outpatient setting,$15.53 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$15.23 ,$69.31 ,$47.42 
Outpatient Medical Services,LAB,86902,"BB ANTIGEN SCREEN PER UNIT, 2AG",302,$290.88 ,$194.89 ,67% of billed charges for outpatient setting,$81.45 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$4.30 ,100% GA Medicaid fee schedule for outpatient setting,$81.45 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$5.25 ,100% BCBS PPO fee schedule for outpatient setting,$261.79 ,90% of billed charges for outpatient setting,$4.47 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$232.70 ,80% of billed charges for outpatient setting,$218.16 ,75% of billed charges for outpatient setting,$82.26 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$4.30 ,100% GA Medicaid fee schedule for outpatient setting,$81.45 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$276.34 ,95% of billed charges for outpatient setting,$4.39 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$247.25 ,85% of billed charges for outpatient setting,$174.53 ,60% of billed charges for outpatient setting,$81.45 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$174.53 ,60% of billed charges for outpatient setting,$4.39 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$4.30 ,$276.34 ,$189.07 
Outpatient Medical Services,LAB,86922,"BB CROSSMATCH, AHG",302,$226.08 ,$151.47 ,67% of billed charges for outpatient setting,$63.30 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$60.52 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$63.30 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$165.04 ,73% of billed charges for outpatient setting,$203.47 ,90% of billed charges for outpatient setting,$62.94 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$180.86 ,80% of billed charges for outpatient setting,$169.56 ,75% of billed charges for outpatient setting,$63.94 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$60.52 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$63.30 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$214.78 ,95% of billed charges for outpatient setting,$61.74 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$192.17 ,85% of billed charges for outpatient setting,$135.65 ,60% of billed charges for outpatient setting,$63.30 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$135.65 ,60% of billed charges for outpatient setting,$61.74 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$60.52 ,$214.78 ,$146.95 
Outpatient Medical Services,LAB,86901,BB RH,302,$29.54 ,$19.79 ,67% of billed charges for outpatient setting,$8.27 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$14.51 ,100% GA Medicaid fee schedule for outpatient setting,$8.27 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$4.10 ,100% BCBS PPO fee schedule for outpatient setting,$26.59 ,90% of billed charges for outpatient setting,$15.09 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$23.63 ,80% of billed charges for outpatient setting,$22.16 ,75% of billed charges for outpatient setting,$8.35 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$14.51 ,100% GA Medicaid fee schedule for outpatient setting,$8.27 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$28.06 ,95% of billed charges for outpatient setting,$14.80 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$25.11 ,85% of billed charges for outpatient setting,$17.72 ,60% of billed charges for outpatient setting,$8.27 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$17.72 ,60% of billed charges for outpatient setting,$14.80 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$4.10 ,$28.06 ,$19.20 
Outpatient Medical Services,LAB,82248,BILIRUBIN DIRECT,301,$35.08 ,$23.50 ,67% of billed charges for outpatient setting,$9.82 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$6.32 ,100% GA Medicaid fee schedule for outpatient setting,$9.82 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$6.90 ,100% BCBS PPO fee schedule for outpatient setting,$31.57 ,90% of billed charges for outpatient setting,$6.57 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$28.06 ,80% of billed charges for outpatient setting,$26.31 ,75% of billed charges for outpatient setting,$9.92 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$6.32 ,100% GA Medicaid fee schedule for outpatient setting,$9.82 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$33.33 ,95% of billed charges for outpatient setting,$6.45 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$29.82 ,85% of billed charges for outpatient setting,$21.05 ,60% of billed charges for outpatient setting,$9.82 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$21.05 ,60% of billed charges for outpatient setting,$6.45 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$6.32 ,$33.33 ,$22.80 
Outpatient Medical Services,LAB,82247,BILIRUBIN TOTAL,301,$84.25 ,$56.45 ,67% of billed charges for outpatient setting,$23.59 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$6.32 ,100% GA Medicaid fee schedule for outpatient setting,$23.59 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$6.90 ,100% BCBS PPO fee schedule for outpatient setting,$75.83 ,90% of billed charges for outpatient setting,$6.57 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$67.40 ,80% of billed charges for outpatient setting,$63.19 ,75% of billed charges for outpatient setting,$23.83 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$6.32 ,100% GA Medicaid fee schedule for outpatient setting,$23.59 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$80.04 ,95% of billed charges for outpatient setting,$6.45 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$71.61 ,85% of billed charges for outpatient setting,$50.55 ,60% of billed charges for outpatient setting,$23.59 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$50.55 ,60% of billed charges for outpatient setting,$6.45 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$6.32 ,$80.04 ,$54.76 
Outpatient Medical Services,LAB,82805,BLOOD GAS VENOUS W/CO-0X,301,$123.36 ,$82.65 ,67% of billed charges for outpatient setting,$34.54 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$35.69 ,100% GA Medicaid fee schedule for outpatient setting,$34.54 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$39.01 ,100% BCBS PPO fee schedule for outpatient setting,$111.02 ,90% of billed charges for outpatient setting,$37.12 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$98.69 ,80% of billed charges for outpatient setting,$92.52 ,75% of billed charges for outpatient setting,$34.89 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$35.69 ,100% GA Medicaid fee schedule for outpatient setting,$34.54 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$117.19 ,95% of billed charges for outpatient setting,$36.40 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$104.86 ,85% of billed charges for outpatient setting,$74.02 ,60% of billed charges for outpatient setting,$34.54 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$74.02 ,60% of billed charges for outpatient setting,$36.40 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$34.54 ,$117.19 ,$80.18 
Outpatient Medical Services,LAB,83880,BNP,301,$140.00 ,$93.80 ,67% of billed charges for outpatient setting,$39.20 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$42.69 ,100% GA Medicaid fee schedule for outpatient setting,$39.20 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$46.66 ,100% BCBS PPO fee schedule for outpatient setting,$126.00 ,90% of billed charges for outpatient setting,$44.40 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$112.00 ,80% of billed charges for outpatient setting,$105.00 ,75% of billed charges for outpatient setting,$39.59 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$42.69 ,100% GA Medicaid fee schedule for outpatient setting,$39.20 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$133.00 ,95% of billed charges for outpatient setting,$43.54 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$119.00 ,85% of billed charges for outpatient setting,$84.00 ,60% of billed charges for outpatient setting,$39.20 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$84.00 ,60% of billed charges for outpatient setting,$43.54 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$39.20 ,$133.00 ,$91.00 
Outpatient Medical Services,LAB,84520,BUN,301,$31.62 ,$21.19 ,67% of billed charges for outpatient setting,$8.85 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$4.96 ,100% GA Medicaid fee schedule for outpatient setting,$8.85 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$5.43 ,100% BCBS PPO fee schedule for outpatient setting,$28.46 ,90% of billed charges for outpatient setting,$5.16 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$25.30 ,80% of billed charges for outpatient setting,$23.72 ,75% of billed charges for outpatient setting,$8.94 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$4.96 ,100% GA Medicaid fee schedule for outpatient setting,$8.85 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$30.04 ,95% of billed charges for outpatient setting,$5.06 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$26.88 ,85% of billed charges for outpatient setting,$18.97 ,60% of billed charges for outpatient setting,$8.85 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$18.97 ,60% of billed charges for outpatient setting,$5.06 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$4.96 ,$30.04 ,$20.55 
Outpatient Medical Services,LAB,87493,C DIFF TOXIN B + 027/NAP1/BI,306,$136.08 ,$91.17 ,67% of billed charges for outpatient setting,$38.10 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$36.43 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$38.10 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$26.97 ,100% BCBS PPO fee schedule for outpatient setting,$122.47 ,90% of billed charges for outpatient setting,$37.89 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$108.86 ,80% of billed charges for outpatient setting,$102.06 ,75% of billed charges for outpatient setting,$38.48 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$36.43 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$38.10 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$129.28 ,95% of billed charges for outpatient setting,$37.16 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$115.67 ,85% of billed charges for outpatient setting,$81.65 ,60% of billed charges for outpatient setting,$38.10 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$81.65 ,60% of billed charges for outpatient setting,$37.16 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$26.97 ,$129.28 ,$88.45 
Outpatient Medical Services,LAB,86140,C REACTIVE PROTEIN,302,$29.49 ,$19.76 ,67% of billed charges for outpatient setting,$8.26 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$6.51 ,100% GA Medicaid fee schedule for outpatient setting,$8.26 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$7.11 ,100% BCBS PPO fee schedule for outpatient setting,$26.54 ,90% of billed charges for outpatient setting,$6.77 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$23.59 ,80% of billed charges for outpatient setting,$22.12 ,75% of billed charges for outpatient setting,$8.34 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$6.51 ,100% GA Medicaid fee schedule for outpatient setting,$8.26 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$28.02 ,95% of billed charges for outpatient setting,$6.64 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$25.07 ,85% of billed charges for outpatient setting,$17.69 ,60% of billed charges for outpatient setting,$8.26 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$17.69 ,60% of billed charges for outpatient setting,$6.64 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$6.51 ,$28.02 ,$19.17 
Outpatient Medical Services,LAB,86304,CA 125,302,$120.00 ,$80.40 ,67% of billed charges for outpatient setting,$33.60 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$26.16 ,100% GA Medicaid fee schedule for outpatient setting,$33.60 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$28.61 ,100% BCBS PPO fee schedule for outpatient setting,$108.00 ,90% of billed charges for outpatient setting,$27.21 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$96.00 ,80% of billed charges for outpatient setting,$90.00 ,75% of billed charges for outpatient setting,$33.94 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$26.16 ,100% GA Medicaid fee schedule for outpatient setting,$33.60 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$114.00 ,95% of billed charges for outpatient setting,$26.68 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$102.00 ,85% of billed charges for outpatient setting,$72.00 ,60% of billed charges for outpatient setting,$33.60 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$72.00 ,60% of billed charges for outpatient setting,$26.68 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$26.16 ,$114.00 ,$78.00 
Outpatient Medical Services,LAB,86301,CA 19-9,300,$99.36 ,$66.57 ,67% of billed charges for outpatient setting,$27.82 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$26.16 ,100% GA Medicaid fee schedule for outpatient setting,$27.82 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$28.61 ,100% BCBS PPO fee schedule for outpatient setting,$89.42 ,90% of billed charges for outpatient setting,$27.21 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$79.49 ,80% of billed charges for outpatient setting,$74.52 ,75% of billed charges for outpatient setting,$28.10 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$26.16 ,100% GA Medicaid fee schedule for outpatient setting,$27.82 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$94.39 ,95% of billed charges for outpatient setting,$26.68 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$84.46 ,85% of billed charges for outpatient setting,$59.62 ,60% of billed charges for outpatient setting,$27.82 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$59.62 ,60% of billed charges for outpatient setting,$26.68 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$26.16 ,$94.39 ,$64.58 
Outpatient Medical Services,LAB,86300,CA 27.29,302,$50.88 ,$34.09 ,67% of billed charges for outpatient setting,$14.25 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$26.16 ,100% GA Medicaid fee schedule for outpatient setting,$14.25 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$28.61 ,100% BCBS PPO fee schedule for outpatient setting,$45.79 ,90% of billed charges for outpatient setting,$27.21 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$40.70 ,80% of billed charges for outpatient setting,$38.16 ,75% of billed charges for outpatient setting,$14.39 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$26.16 ,100% GA Medicaid fee schedule for outpatient setting,$14.25 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$48.34 ,95% of billed charges for outpatient setting,$26.68 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$43.25 ,85% of billed charges for outpatient setting,$30.53 ,60% of billed charges for outpatient setting,$14.25 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$30.53 ,60% of billed charges for outpatient setting,$26.68 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$14.25 ,$48.34 ,$33.07 
Outpatient Medical Services,LAB,82310,CALCIUM,301,$65.45 ,$43.85 ,67% of billed charges for outpatient setting,$18.33 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$6.35 ,100% GA Medicaid fee schedule for outpatient setting,$18.33 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$7.09 ,100% BCBS PPO fee schedule for outpatient setting,$58.91 ,90% of billed charges for outpatient setting,$6.60 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$52.36 ,80% of billed charges for outpatient setting,$49.09 ,75% of billed charges for outpatient setting,$18.51 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$6.35 ,100% GA Medicaid fee schedule for outpatient setting,$18.33 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$62.18 ,95% of billed charges for outpatient setting,$6.48 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$55.63 ,85% of billed charges for outpatient setting,$39.27 ,60% of billed charges for outpatient setting,$18.33 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$39.27 ,60% of billed charges for outpatient setting,$6.48 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$6.35 ,$62.18 ,$42.54 
Outpatient Medical Services,LAB,87899,CAMPYLOBACTER ANTIGEN,306,$213.00 ,$142.71 ,67% of billed charges for outpatient setting,$59.64 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,$59.64 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.49 ,100% BCBS PPO fee schedule for outpatient setting,$191.70 ,90% of billed charges for outpatient setting,$15.68 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$170.40 ,80% of billed charges for outpatient setting,$159.75 ,75% of billed charges for outpatient setting,$60.24 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,$59.64 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$202.35 ,95% of billed charges for outpatient setting,$15.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$181.05 ,85% of billed charges for outpatient setting,$127.80 ,60% of billed charges for outpatient setting,$59.64 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$127.80 ,60% of billed charges for outpatient setting,$15.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$15.08 ,$202.35 ,$138.45 
Outpatient Medical Services,LAB,87481,CANDIDA SPECIES AMPLIFIED PROBE,306,$160.00 ,$107.20 ,67% of billed charges for outpatient setting,$44.80 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$24.67 ,100% GA Medicaid fee schedule for outpatient setting,$44.80 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$26.97 ,100% BCBS PPO fee schedule for outpatient setting,$144.00 ,90% of billed charges for outpatient setting,$25.66 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$128.00 ,80% of billed charges for outpatient setting,$120.00 ,75% of billed charges for outpatient setting,$45.25 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$24.67 ,100% GA Medicaid fee schedule for outpatient setting,$44.80 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$152.00 ,95% of billed charges for outpatient setting,$25.16 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$136.00 ,85% of billed charges for outpatient setting,$96.00 ,60% of billed charges for outpatient setting,$44.80 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$96.00 ,60% of billed charges for outpatient setting,$25.16 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$24.67 ,$152.00 ,$104.00 
Outpatient Medical Services,LAB,85025,CBC W/ AUTO DIFF/PLATELETS CHG ONLY,305,$46.56 ,$31.20 ,67% of billed charges for outpatient setting,$13.04 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$9.77 ,100% GA Medicaid fee schedule for outpatient setting,$13.04 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$10.69 ,100% BCBS PPO fee schedule for outpatient setting,$41.90 ,90% of billed charges for outpatient setting,$10.16 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$37.25 ,80% of billed charges for outpatient setting,$34.92 ,75% of billed charges for outpatient setting,$13.17 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$9.77 ,100% GA Medicaid fee schedule for outpatient setting,$13.04 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$44.23 ,95% of billed charges for outpatient setting,$9.97 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$39.58 ,85% of billed charges for outpatient setting,$27.94 ,60% of billed charges for outpatient setting,$13.04 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$27.94 ,60% of billed charges for outpatient setting,$9.97 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$9.77 ,$44.23 ,$30.26 
Outpatient Medical Services,LAB,85027,CBC WITH NO DIFF,305,$118.69 ,$79.52 ,67% of billed charges for outpatient setting,$33.23 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$8.14 ,100% GA Medicaid fee schedule for outpatient setting,$33.23 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$8.89 ,100% BCBS PPO fee schedule for outpatient setting,$106.82 ,90% of billed charges for outpatient setting,$8.47 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$94.95 ,80% of billed charges for outpatient setting,$89.02 ,75% of billed charges for outpatient setting,$33.57 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$8.14 ,100% GA Medicaid fee schedule for outpatient setting,$33.23 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$112.76 ,95% of billed charges for outpatient setting,$8.30 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$100.89 ,85% of billed charges for outpatient setting,$71.21 ,60% of billed charges for outpatient setting,$33.23 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$71.21 ,60% of billed charges for outpatient setting,$8.30 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$8.14 ,$112.76 ,$77.15 
Outpatient Medical Services,LAB,82378,CEA,301,$126.24 ,$84.58 ,67% of billed charges for outpatient setting,$35.35 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$23.86 ,100% GA Medicaid fee schedule for outpatient setting,$35.35 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$26.08 ,100% BCBS PPO fee schedule for outpatient setting,$113.62 ,90% of billed charges for outpatient setting,$24.81 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$100.99 ,80% of billed charges for outpatient setting,$94.68 ,75% of billed charges for outpatient setting,$35.70 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$23.86 ,100% GA Medicaid fee schedule for outpatient setting,$35.35 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$119.93 ,95% of billed charges for outpatient setting,$24.34 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$107.30 ,85% of billed charges for outpatient setting,$75.74 ,60% of billed charges for outpatient setting,$35.35 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$75.74 ,60% of billed charges for outpatient setting,$24.34 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$23.86 ,$119.93 ,$82.06 
Outpatient Medical Services,LAB,87491,CHLAMYDIA DNA PROBE,306,$95.52 ,$64.00 ,67% of billed charges for outpatient setting,$26.75 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$24.67 ,100% GA Medicaid fee schedule for outpatient setting,$26.75 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$26.97 ,100% BCBS PPO fee schedule for outpatient setting,$85.97 ,90% of billed charges for outpatient setting,$25.66 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$76.42 ,80% of billed charges for outpatient setting,$71.64 ,75% of billed charges for outpatient setting,$27.01 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$24.67 ,100% GA Medicaid fee schedule for outpatient setting,$26.75 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$90.74 ,95% of billed charges for outpatient setting,$25.16 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$81.19 ,85% of billed charges for outpatient setting,$57.31 ,60% of billed charges for outpatient setting,$26.75 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$57.31 ,60% of billed charges for outpatient setting,$25.16 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$24.67 ,$90.74 ,$62.09 
Outpatient Medical Services,LAB,82465,CHOLESTEROL,301,$69.59 ,$46.63 ,67% of billed charges for outpatient setting,$19.49 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$5.47 ,100% GA Medicaid fee schedule for outpatient setting,$19.49 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$5.98 ,100% BCBS PPO fee schedule for outpatient setting,$62.63 ,90% of billed charges for outpatient setting,$5.69 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$55.67 ,80% of billed charges for outpatient setting,$52.19 ,75% of billed charges for outpatient setting,$19.68 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$5.47 ,100% GA Medicaid fee schedule for outpatient setting,$19.49 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$66.11 ,95% of billed charges for outpatient setting,$5.58 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$59.15 ,85% of billed charges for outpatient setting,$41.75 ,60% of billed charges for outpatient setting,$19.49 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$41.75 ,60% of billed charges for outpatient setting,$5.58 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$5.47 ,$66.11 ,$45.23 
Outpatient Medical Services,LAB,82553,CKMB,301,$44.16 ,$29.59 ,67% of billed charges for outpatient setting,$12.36 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$14.52 ,100% GA Medicaid fee schedule for outpatient setting,$12.36 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$15.87 ,100% BCBS PPO fee schedule for outpatient setting,$39.74 ,90% of billed charges for outpatient setting,$15.10 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$35.33 ,80% of billed charges for outpatient setting,$33.12 ,75% of billed charges for outpatient setting,$12.49 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$14.52 ,100% GA Medicaid fee schedule for outpatient setting,$12.36 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$41.95 ,95% of billed charges for outpatient setting,$14.81 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$37.54 ,85% of billed charges for outpatient setting,$26.50 ,60% of billed charges for outpatient setting,$12.36 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$26.50 ,60% of billed charges for outpatient setting,$14.81 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$12.36 ,$41.95 ,$28.70 
Outpatient Medical Services,LAB,86923,COMPATIBILITY TEST ELECTRONIC,300,$133.12 ,$89.19 ,67% of billed charges for outpatient setting,$37.27 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$35.64 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$37.27 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$97.18 ,73% of billed charges for outpatient setting,$119.81 ,90% of billed charges for outpatient setting,$37.07 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$106.50 ,80% of billed charges for outpatient setting,$99.84 ,75% of billed charges for outpatient setting,$37.65 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$35.64 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$37.27 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$126.46 ,95% of billed charges for outpatient setting,$36.36 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$113.15 ,85% of billed charges for outpatient setting,$79.87 ,60% of billed charges for outpatient setting,$37.27 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$79.87 ,60% of billed charges for outpatient setting,$36.36 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$35.64 ,$126.46 ,$86.53 
Outpatient Medical Services,LAB,80053,COMPREHENSIVE METABOLIC PANEL,301,$89.76 ,$60.14 ,67% of billed charges for outpatient setting,$25.13 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$13.29 ,100% GA Medicaid fee schedule for outpatient setting,$25.13 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$14.53 ,100% BCBS PPO fee schedule for outpatient setting,$80.78 ,90% of billed charges for outpatient setting,$13.82 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$71.81 ,80% of billed charges for outpatient setting,$67.32 ,75% of billed charges for outpatient setting,$25.38 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$13.29 ,100% GA Medicaid fee schedule for outpatient setting,$25.13 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$85.27 ,95% of billed charges for outpatient setting,$13.56 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$76.30 ,85% of billed charges for outpatient setting,$53.86 ,60% of billed charges for outpatient setting,$25.13 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$53.86 ,60% of billed charges for outpatient setting,$13.56 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$13.29 ,$85.27 ,$58.34 
Outpatient Medical Services,LAB,87015,CONCENTRATION INFECTIOUS AGENTS,306,$23.52 ,$15.76 ,67% of billed charges for outpatient setting,$6.59 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$8.40 ,100% GA Medicaid fee schedule for outpatient setting,$6.59 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$9.18 ,100% BCBS PPO fee schedule for outpatient setting,$21.17 ,90% of billed charges for outpatient setting,$8.74 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$18.82 ,80% of billed charges for outpatient setting,$17.64 ,75% of billed charges for outpatient setting,$6.65 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$8.40 ,100% GA Medicaid fee schedule for outpatient setting,$6.59 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$22.34 ,95% of billed charges for outpatient setting,$8.57 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$19.99 ,85% of billed charges for outpatient setting,$14.11 ,60% of billed charges for outpatient setting,$6.59 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$14.11 ,60% of billed charges for outpatient setting,$8.57 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$6.59 ,$22.34 ,$15.29 
Outpatient Medical Services,LAB,82550,CPK,301,$47.04 ,$31.52 ,67% of billed charges for outpatient setting,$13.17 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$6.35 ,100% GA Medicaid fee schedule for outpatient setting,$13.17 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$8.95 ,100% BCBS PPO fee schedule for outpatient setting,$42.34 ,90% of billed charges for outpatient setting,$6.60 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$37.63 ,80% of billed charges for outpatient setting,$35.28 ,75% of billed charges for outpatient setting,$13.30 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$6.35 ,100% GA Medicaid fee schedule for outpatient setting,$13.17 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$44.69 ,95% of billed charges for outpatient setting,$6.48 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$39.98 ,85% of billed charges for outpatient setting,$28.22 ,60% of billed charges for outpatient setting,$13.17 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$28.22 ,60% of billed charges for outpatient setting,$6.48 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$6.35 ,$44.69 ,$30.58 
Outpatient Medical Services,LAB,82565,CREATININE,301,$33.12 ,$22.19 ,67% of billed charges for outpatient setting,$9.27 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$6.35 ,100% GA Medicaid fee schedule for outpatient setting,$9.27 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$7.04 ,100% BCBS PPO fee schedule for outpatient setting,$29.81 ,90% of billed charges for outpatient setting,$6.60 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$26.50 ,80% of billed charges for outpatient setting,$24.84 ,75% of billed charges for outpatient setting,$9.37 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$6.35 ,100% GA Medicaid fee schedule for outpatient setting,$9.27 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$31.46 ,95% of billed charges for outpatient setting,$6.48 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$28.15 ,85% of billed charges for outpatient setting,$19.87 ,60% of billed charges for outpatient setting,$9.27 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$19.87 ,60% of billed charges for outpatient setting,$6.48 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$6.35 ,$31.46 ,$21.53 
Outpatient Medical Services,LAB,82575,CREATININE CLEARANCE,301,$79.56 ,$53.31 ,67% of billed charges for outpatient setting,$22.28 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$11.88 ,100% GA Medicaid fee schedule for outpatient setting,$22.28 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$12.99 ,100% BCBS PPO fee schedule for outpatient setting,$71.60 ,90% of billed charges for outpatient setting,$12.36 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$63.65 ,80% of billed charges for outpatient setting,$59.67 ,75% of billed charges for outpatient setting,$22.50 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$11.88 ,100% GA Medicaid fee schedule for outpatient setting,$22.28 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$75.58 ,95% of billed charges for outpatient setting,$12.12 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$67.63 ,85% of billed charges for outpatient setting,$47.74 ,60% of billed charges for outpatient setting,$22.28 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$47.74 ,60% of billed charges for outpatient setting,$12.12 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$11.88 ,$75.58 ,$51.71 
Outpatient Medical Services,LAB,82570,CREATININE URINE,301,$29.51 ,$19.77 ,67% of billed charges for outpatient setting,$8.26 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$6.51 ,100% GA Medicaid fee schedule for outpatient setting,$8.26 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$7.11 ,100% BCBS PPO fee schedule for outpatient setting,$26.56 ,90% of billed charges for outpatient setting,$6.77 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$23.61 ,80% of billed charges for outpatient setting,$22.13 ,75% of billed charges for outpatient setting,$8.35 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$6.51 ,100% GA Medicaid fee schedule for outpatient setting,$8.26 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$28.03 ,95% of billed charges for outpatient setting,$6.64 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$25.08 ,85% of billed charges for outpatient setting,$17.71 ,60% of billed charges for outpatient setting,$8.26 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$17.71 ,60% of billed charges for outpatient setting,$6.64 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$6.51 ,$28.03 ,$19.18 
Outpatient Medical Services,LAB,87328,CRYPTOSPORIDIUM ANTIGEN,306,$126.39 ,$84.68 ,67% of billed charges for outpatient setting,$35.39 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,$35.39 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.49 ,100% BCBS PPO fee schedule for outpatient setting,$113.75 ,90% of billed charges for outpatient setting,$15.68 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$101.11 ,80% of billed charges for outpatient setting,$94.79 ,75% of billed charges for outpatient setting,$35.74 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,$35.39 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$120.07 ,95% of billed charges for outpatient setting,$15.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$107.43 ,85% of billed charges for outpatient setting,$75.83 ,60% of billed charges for outpatient setting,$35.39 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$75.83 ,60% of billed charges for outpatient setting,$15.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$15.08 ,$120.07 ,$82.15 
Outpatient Medical Services,LAB,87075,CULTURE AEROBIC AND ANAEROBIC,306,$345.27 ,$231.33 ,67% of billed charges for outpatient setting,$96.68 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$11.90 ,100% GA Medicaid fee schedule for outpatient setting,$96.68 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$13.01 ,100% BCBS PPO fee schedule for outpatient setting,$310.74 ,90% of billed charges for outpatient setting,$12.38 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$276.22 ,80% of billed charges for outpatient setting,$258.95 ,75% of billed charges for outpatient setting,$97.64 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$11.90 ,100% GA Medicaid fee schedule for outpatient setting,$96.68 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$328.01 ,95% of billed charges for outpatient setting,$12.14 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$293.48 ,85% of billed charges for outpatient setting,$207.16 ,60% of billed charges for outpatient setting,$96.68 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$207.16 ,60% of billed charges for outpatient setting,$12.14 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$11.90 ,$328.01 ,$224.43 
Outpatient Medical Services,LAB,87040,CULTURE BLOOD,306,$113.00 ,$75.71 ,67% of billed charges for outpatient setting,$31.64 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$12.98 ,100% GA Medicaid fee schedule for outpatient setting,$31.64 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$14.19 ,100% BCBS PPO fee schedule for outpatient setting,$101.70 ,90% of billed charges for outpatient setting,$13.50 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$90.40 ,80% of billed charges for outpatient setting,$84.75 ,75% of billed charges for outpatient setting,$31.96 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$12.98 ,100% GA Medicaid fee schedule for outpatient setting,$31.64 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$107.35 ,95% of billed charges for outpatient setting,$13.24 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$96.05 ,85% of billed charges for outpatient setting,$67.80 ,60% of billed charges for outpatient setting,$31.64 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$67.80 ,60% of billed charges for outpatient setting,$13.24 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$12.98 ,$107.35 ,$73.45 
Outpatient Medical Services,LAB,87070,CULTURE BODY FLUID,306,$207.35 ,$138.92 ,67% of billed charges for outpatient setting,$58.06 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$10.83 ,100% GA Medicaid fee schedule for outpatient setting,$58.06 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$11.84 ,100% BCBS PPO fee schedule for outpatient setting,$186.62 ,90% of billed charges for outpatient setting,$11.26 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$165.88 ,80% of billed charges for outpatient setting,$155.51 ,75% of billed charges for outpatient setting,$58.64 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$10.83 ,100% GA Medicaid fee schedule for outpatient setting,$58.06 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$196.98 ,95% of billed charges for outpatient setting,$11.05 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$176.25 ,85% of billed charges for outpatient setting,$124.41 ,60% of billed charges for outpatient setting,$58.06 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$124.41 ,60% of billed charges for outpatient setting,$11.05 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$10.83 ,$196.98 ,$134.78 
Outpatient Medical Services,LAB,87070,CULTURE SPUTUM WITH GRAM STAIN,306,$207.35 ,$138.92 ,67% of billed charges for outpatient setting,$58.06 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$10.83 ,100% GA Medicaid fee schedule for outpatient setting,$58.06 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$11.84 ,100% BCBS PPO fee schedule for outpatient setting,$186.62 ,90% of billed charges for outpatient setting,$11.26 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$165.88 ,80% of billed charges for outpatient setting,$155.51 ,75% of billed charges for outpatient setting,$58.64 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$10.83 ,100% GA Medicaid fee schedule for outpatient setting,$58.06 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$196.98 ,95% of billed charges for outpatient setting,$11.05 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$176.25 ,85% of billed charges for outpatient setting,$124.41 ,60% of billed charges for outpatient setting,$58.06 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$124.41 ,60% of billed charges for outpatient setting,$11.05 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$10.83 ,$196.98 ,$134.78 
Outpatient Medical Services,LAB,87045,CULTURE STOOL,306,$63.72 ,$42.69 ,67% of billed charges for outpatient setting,$17.84 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$17.06 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$17.84 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$12.97 ,100% BCBS PPO fee schedule for outpatient setting,$57.35 ,90% of billed charges for outpatient setting,$17.74 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$50.98 ,80% of billed charges for outpatient setting,$47.79 ,75% of billed charges for outpatient setting,$18.02 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$17.06 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$17.84 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$60.53 ,95% of billed charges for outpatient setting,$17.40 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$54.16 ,85% of billed charges for outpatient setting,$38.23 ,60% of billed charges for outpatient setting,$17.84 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$38.23 ,60% of billed charges for outpatient setting,$17.40 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$12.97 ,$60.53 ,$41.42 
Outpatient Medical Services,LAB,87046,"CULTURE STOOL, ADDITIONAL PATHOGENS",306,$24.00 ,$16.08 ,67% of billed charges for outpatient setting,$6.72 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$2.97 ,100% GA Medicaid fee schedule for outpatient setting,$6.72 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$12.97 ,100% BCBS PPO fee schedule for outpatient setting,$21.60 ,90% of billed charges for outpatient setting,$3.09 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$19.20 ,80% of billed charges for outpatient setting,$18.00 ,75% of billed charges for outpatient setting,$6.79 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$2.97 ,100% GA Medicaid fee schedule for outpatient setting,$6.72 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$22.80 ,95% of billed charges for outpatient setting,$3.03 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$20.40 ,85% of billed charges for outpatient setting,$14.40 ,60% of billed charges for outpatient setting,$6.72 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$14.40 ,60% of billed charges for outpatient setting,$3.03 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$2.97 ,$22.80 ,$15.60 
Outpatient Medical Services,LAB,87070,CULTURE THROAT,306,$207.35 ,$138.92 ,67% of billed charges for outpatient setting,$58.06 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$10.83 ,100% GA Medicaid fee schedule for outpatient setting,$58.06 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$11.84 ,100% BCBS PPO fee schedule for outpatient setting,$186.62 ,90% of billed charges for outpatient setting,$11.26 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$165.88 ,80% of billed charges for outpatient setting,$155.51 ,75% of billed charges for outpatient setting,$58.64 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$10.83 ,100% GA Medicaid fee schedule for outpatient setting,$58.06 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$196.98 ,95% of billed charges for outpatient setting,$11.05 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$176.25 ,85% of billed charges for outpatient setting,$124.41 ,60% of billed charges for outpatient setting,$58.06 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$124.41 ,60% of billed charges for outpatient setting,$11.05 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$10.83 ,$196.98 ,$134.78 
Outpatient Medical Services,LAB,87086,CULTURE URINE,306,$53.76 ,$36.02 ,67% of billed charges for outpatient setting,$15.05 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$10.15 ,100% GA Medicaid fee schedule for outpatient setting,$15.05 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$11.10 ,100% BCBS PPO fee schedule for outpatient setting,$48.38 ,90% of billed charges for outpatient setting,$10.56 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$43.01 ,80% of billed charges for outpatient setting,$40.32 ,75% of billed charges for outpatient setting,$15.20 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$10.15 ,100% GA Medicaid fee schedule for outpatient setting,$15.05 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$51.07 ,95% of billed charges for outpatient setting,$10.35 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$45.70 ,85% of billed charges for outpatient setting,$32.26 ,60% of billed charges for outpatient setting,$15.05 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$32.26 ,60% of billed charges for outpatient setting,$10.35 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$10.15 ,$51.07 ,$34.94 
Outpatient Medical Services,LAB,87070,"CULTURE WOUND, AEROBIC ONLY",306,$207.35 ,$138.92 ,67% of billed charges for outpatient setting,$58.06 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$10.83 ,100% GA Medicaid fee schedule for outpatient setting,$58.06 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$11.84 ,100% BCBS PPO fee schedule for outpatient setting,$186.62 ,90% of billed charges for outpatient setting,$11.26 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$165.88 ,80% of billed charges for outpatient setting,$155.51 ,75% of billed charges for outpatient setting,$58.64 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$10.83 ,100% GA Medicaid fee schedule for outpatient setting,$58.06 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$196.98 ,95% of billed charges for outpatient setting,$11.05 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$176.25 ,85% of billed charges for outpatient setting,$124.41 ,60% of billed charges for outpatient setting,$58.06 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$124.41 ,60% of billed charges for outpatient setting,$11.05 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$10.83 ,$196.98 ,$134.78 
Outpatient Medical Services,LAB,86200,CYCLIC CITRULLINATED PEPTIDE,300,$263.75 ,$176.71 ,67% of billed charges for outpatient setting,$73.85 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.28 ,100% GA Medicaid fee schedule for outpatient setting,$73.85 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$17.80 ,100% BCBS PPO fee schedule for outpatient setting,$237.38 ,90% of billed charges for outpatient setting,$16.93 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$211.00 ,80% of billed charges for outpatient setting,$197.81 ,75% of billed charges for outpatient setting,$74.59 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$16.28 ,100% GA Medicaid fee schedule for outpatient setting,$73.85 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$250.56 ,95% of billed charges for outpatient setting,$16.61 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$224.19 ,85% of billed charges for outpatient setting,$158.25 ,60% of billed charges for outpatient setting,$73.85 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$158.25 ,60% of billed charges for outpatient setting,$16.61 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$16.28 ,$250.56 ,$171.44 
Outpatient Medical Services,LAB,88142,CYTOLOGY PAP THIN PREP,311,$120.12 ,$80.48 ,67% of billed charges for outpatient setting,$33.63 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$25.48 ,100% GA Medicaid fee schedule for outpatient setting,$33.63 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$27.85 ,100% BCBS PPO fee schedule for outpatient setting,$108.11 ,90% of billed charges for outpatient setting,$26.50 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$96.10 ,80% of billed charges for outpatient setting,$90.09 ,75% of billed charges for outpatient setting,$33.97 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$25.48 ,100% GA Medicaid fee schedule for outpatient setting,$33.63 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$114.11 ,95% of billed charges for outpatient setting,$25.99 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$102.10 ,85% of billed charges for outpatient setting,$72.07 ,60% of billed charges for outpatient setting,$33.63 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$72.07 ,60% of billed charges for outpatient setting,$25.99 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$25.48 ,$114.11 ,$78.08 
Outpatient Medical Services,LAB,85379,D-DIMER,305,$123.36 ,$82.65 ,67% of billed charges for outpatient setting,$34.54 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$12.80 ,100% GA Medicaid fee schedule for outpatient setting,$34.54 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$13.99 ,100% BCBS PPO fee schedule for outpatient setting,$111.02 ,90% of billed charges for outpatient setting,$13.31 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$98.69 ,80% of billed charges for outpatient setting,$92.52 ,75% of billed charges for outpatient setting,$34.89 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$12.80 ,100% GA Medicaid fee schedule for outpatient setting,$34.54 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$117.19 ,95% of billed charges for outpatient setting,$13.06 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$104.86 ,85% of billed charges for outpatient setting,$74.02 ,60% of billed charges for outpatient setting,$34.54 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$74.02 ,60% of billed charges for outpatient setting,$13.06 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$12.80 ,$117.19 ,$80.18 
Outpatient Medical Services,LAB,80162,DIGOXIN TOTAL,301,$48.48 ,$32.48 ,67% of billed charges for outpatient setting,$13.57 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.70 ,100% GA Medicaid fee schedule for outpatient setting,$13.57 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$18.25 ,100% BCBS PPO fee schedule for outpatient setting,$43.63 ,90% of billed charges for outpatient setting,$17.37 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$38.78 ,80% of billed charges for outpatient setting,$36.36 ,75% of billed charges for outpatient setting,$13.71 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$16.70 ,100% GA Medicaid fee schedule for outpatient setting,$13.57 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$46.06 ,95% of billed charges for outpatient setting,$17.03 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$41.21 ,85% of billed charges for outpatient setting,$29.09 ,60% of billed charges for outpatient setting,$13.57 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$29.09 ,60% of billed charges for outpatient setting,$17.03 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$13.57 ,$46.06 ,$31.51 
Outpatient Medical Services,LAB,80306,DRUG,301,$175.00 ,$117.25 ,67% of billed charges for outpatient setting,$49.00 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$15.29 ,100% GA Medicaid fee schedule for outpatient setting,$49.00 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$127.75 ,73% of billed charges for outpatient setting,$157.50 ,90% of billed charges for outpatient setting,$15.90 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$140.00 ,80% of billed charges for outpatient setting,$131.25 ,75% of billed charges for outpatient setting,$49.49 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$15.29 ,100% GA Medicaid fee schedule for outpatient setting,$49.00 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$166.25 ,95% of billed charges for outpatient setting,$15.60 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$148.75 ,85% of billed charges for outpatient setting,$105.00 ,60% of billed charges for outpatient setting,$49.00 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$105.00 ,60% of billed charges for outpatient setting,$15.60 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$15.29 ,$166.25 ,$113.75 
Outpatient Medical Services,LAB,80306,"DRUG SCREEN MEDICAL, UR",301,$175.00 ,$117.25 ,67% of billed charges for outpatient setting,$49.00 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$15.29 ,100% GA Medicaid fee schedule for outpatient setting,$49.00 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$127.75 ,73% of billed charges for outpatient setting,$157.50 ,90% of billed charges for outpatient setting,$15.90 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$140.00 ,80% of billed charges for outpatient setting,$131.25 ,75% of billed charges for outpatient setting,$49.49 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$15.29 ,100% GA Medicaid fee schedule for outpatient setting,$49.00 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$166.25 ,95% of billed charges for outpatient setting,$15.60 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$148.75 ,85% of billed charges for outpatient setting,$105.00 ,60% of billed charges for outpatient setting,$49.00 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$105.00 ,60% of billed charges for outpatient setting,$15.60 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$15.29 ,$166.25 ,$113.75 
Outpatient Medical Services,LAB,80307,"DRUG SCREEN, LEGAL UR",301,$188.76 ,$126.47 ,67% of billed charges for outpatient setting,$52.85 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$61.16 ,100% GA Medicaid fee schedule for outpatient setting,$52.85 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$137.79 ,73% of billed charges for outpatient setting,$169.88 ,90% of billed charges for outpatient setting,$63.61 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$151.01 ,80% of billed charges for outpatient setting,$141.57 ,75% of billed charges for outpatient setting,$53.38 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$61.16 ,100% GA Medicaid fee schedule for outpatient setting,$52.85 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$179.32 ,95% of billed charges for outpatient setting,$62.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$160.45 ,85% of billed charges for outpatient setting,$113.26 ,60% of billed charges for outpatient setting,$52.85 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$113.26 ,60% of billed charges for outpatient setting,$62.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$52.85 ,$179.32 ,$122.69 
Outpatient Medical Services,LAB,82670,ESTRADIOL,301,$163.02 ,$109.22 ,67% of billed charges for outpatient setting,$45.65 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$35.14 ,100% GA Medicaid fee schedule for outpatient setting,$45.65 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$38.41 ,100% BCBS PPO fee schedule for outpatient setting,$146.72 ,90% of billed charges for outpatient setting,$36.55 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$130.42 ,80% of billed charges for outpatient setting,$122.27 ,75% of billed charges for outpatient setting,$46.10 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$35.14 ,100% GA Medicaid fee schedule for outpatient setting,$45.65 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$154.87 ,95% of billed charges for outpatient setting,$35.84 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$138.57 ,85% of billed charges for outpatient setting,$97.81 ,60% of billed charges for outpatient setting,$45.65 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$97.81 ,60% of billed charges for outpatient setting,$35.84 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$35.14 ,$154.87 ,$105.96 
Outpatient Medical Services,LAB,89055,FECAL LEUKOCYTES,306,$110.00 ,$73.70 ,67% of billed charges for outpatient setting,$30.80 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$2.95 ,100% GA Medicaid fee schedule for outpatient setting,$30.80 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$3.22 ,100% BCBS PPO fee schedule for outpatient setting,$99.00 ,90% of billed charges for outpatient setting,$3.07 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$88.00 ,80% of billed charges for outpatient setting,$82.50 ,75% of billed charges for outpatient setting,$31.11 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$2.95 ,100% GA Medicaid fee schedule for outpatient setting,$30.80 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$104.50 ,95% of billed charges for outpatient setting,$3.01 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$93.50 ,85% of billed charges for outpatient setting,$66.00 ,60% of billed charges for outpatient setting,$30.80 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$66.00 ,60% of billed charges for outpatient setting,$3.01 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$2.95 ,$104.50 ,$71.50 
Outpatient Medical Services,LAB,82728,FERRITIN,301,$55.20 ,$36.98 ,67% of billed charges for outpatient setting,$15.46 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$17.13 ,100% GA Medicaid fee schedule for outpatient setting,$15.46 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$18.73 ,100% BCBS PPO fee schedule for outpatient setting,$49.68 ,90% of billed charges for outpatient setting,$17.82 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$44.16 ,80% of billed charges for outpatient setting,$41.40 ,75% of billed charges for outpatient setting,$15.61 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$17.13 ,100% GA Medicaid fee schedule for outpatient setting,$15.46 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$52.44 ,95% of billed charges for outpatient setting,$17.47 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$46.92 ,85% of billed charges for outpatient setting,$33.12 ,60% of billed charges for outpatient setting,$15.46 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$33.12 ,60% of billed charges for outpatient setting,$17.47 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$15.46 ,$52.44 ,$35.88 
Outpatient Medical Services,LAB,88189,FLOW CYTOMETRY  INTERP 16/> MARKERS,310,$162.72 ,$109.02 ,67% of billed charges for outpatient setting,$45.56 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$98.26 ,100% GA Medicaid fee schedule for outpatient setting,$45.56 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$118.79 ,73% of billed charges for outpatient setting,$146.45 ,90% of billed charges for outpatient setting,$102.19 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$130.18 ,80% of billed charges for outpatient setting,$122.04 ,75% of billed charges for outpatient setting,$46.02 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$98.26 ,100% GA Medicaid fee schedule for outpatient setting,$45.56 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$154.58 ,95% of billed charges for outpatient setting,$100.23 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$138.31 ,85% of billed charges for outpatient setting,$97.63 ,60% of billed charges for outpatient setting,$45.56 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$97.63 ,60% of billed charges for outpatient setting,$100.23 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$45.56 ,$154.58 ,$105.77 
Outpatient Medical Services,LAB,88184,FLOW CYTOMETRY 1ST MARKER,311,$162.72 ,$109.02 ,67% of billed charges for outpatient setting,$45.56 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$46.10 ,100% GA Medicaid fee schedule for outpatient setting,$45.56 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$118.79 ,73% of billed charges for outpatient setting,$146.45 ,90% of billed charges for outpatient setting,$47.94 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$130.18 ,80% of billed charges for outpatient setting,$122.04 ,75% of billed charges for outpatient setting,$46.02 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$46.10 ,100% GA Medicaid fee schedule for outpatient setting,$45.56 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$154.58 ,95% of billed charges for outpatient setting,$47.02 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$138.31 ,85% of billed charges for outpatient setting,$97.63 ,60% of billed charges for outpatient setting,$45.56 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$97.63 ,60% of billed charges for outpatient setting,$47.02 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$45.56 ,$154.58 ,$105.77 
Outpatient Medical Services,LAB,88185,FLOW CYTOMETRY ADDTIONAL MARKER,311,$123.36 ,$82.65 ,67% of billed charges for outpatient setting,$34.54 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$22.67 ,100% GA Medicaid fee schedule for outpatient setting,$34.54 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$90.05 ,73% of billed charges for outpatient setting,$111.02 ,90% of billed charges for outpatient setting,$23.58 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$98.69 ,80% of billed charges for outpatient setting,$92.52 ,75% of billed charges for outpatient setting,$34.89 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$22.67 ,100% GA Medicaid fee schedule for outpatient setting,$34.54 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$117.19 ,95% of billed charges for outpatient setting,$23.12 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$104.86 ,85% of billed charges for outpatient setting,$74.02 ,60% of billed charges for outpatient setting,$34.54 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$74.02 ,60% of billed charges for outpatient setting,$23.12 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$22.67 ,$117.19 ,$80.18 
Outpatient Medical Services,LAB,82747,"FOLATE, RBC",300,$171.07 ,$114.62 ,67% of billed charges for outpatient setting,$47.90 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$21.78 ,100% GA Medicaid fee schedule for outpatient setting,$47.90 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$23.81 ,100% BCBS PPO fee schedule for outpatient setting,$153.96 ,90% of billed charges for outpatient setting,$22.65 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$136.86 ,80% of billed charges for outpatient setting,$128.30 ,75% of billed charges for outpatient setting,$48.38 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$21.78 ,100% GA Medicaid fee schedule for outpatient setting,$47.90 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$162.52 ,95% of billed charges for outpatient setting,$22.22 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$145.41 ,85% of billed charges for outpatient setting,$102.64 ,60% of billed charges for outpatient setting,$47.90 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$102.64 ,60% of billed charges for outpatient setting,$22.22 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$21.78 ,$162.52 ,$111.20 
Outpatient Medical Services,LAB,82746,"FOLATE, SERUM",301,$68.64 ,$45.99 ,67% of billed charges for outpatient setting,$19.22 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$18.49 ,100% GA Medicaid fee schedule for outpatient setting,$19.22 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$20.21 ,100% BCBS PPO fee schedule for outpatient setting,$61.78 ,90% of billed charges for outpatient setting,$19.23 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$54.91 ,80% of billed charges for outpatient setting,$51.48 ,75% of billed charges for outpatient setting,$19.41 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$18.49 ,100% GA Medicaid fee schedule for outpatient setting,$19.22 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$65.21 ,95% of billed charges for outpatient setting,$18.86 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$58.34 ,85% of billed charges for outpatient setting,$41.18 ,60% of billed charges for outpatient setting,$19.22 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$41.18 ,60% of billed charges for outpatient setting,$18.86 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$18.49 ,$65.21 ,$44.62 
Outpatient Medical Services,LAB,83001,FSH,301,$258.00 ,$172.86 ,67% of billed charges for outpatient setting,$72.24 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$23.37 ,100% GA Medicaid fee schedule for outpatient setting,$72.24 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$25.54 ,100% BCBS PPO fee schedule for outpatient setting,$232.20 ,90% of billed charges for outpatient setting,$24.30 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$206.40 ,80% of billed charges for outpatient setting,$193.50 ,75% of billed charges for outpatient setting,$72.96 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$23.37 ,100% GA Medicaid fee schedule for outpatient setting,$72.24 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$245.10 ,95% of billed charges for outpatient setting,$23.84 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$219.30 ,85% of billed charges for outpatient setting,$154.80 ,60% of billed charges for outpatient setting,$72.24 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$154.80 ,60% of billed charges for outpatient setting,$23.84 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$23.37 ,$245.10 ,$167.70 
Outpatient Medical Services,LAB,87591,GC DNA PROBE,306,$60.96 ,$40.84 ,67% of billed charges for outpatient setting,$17.07 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$21.42 ,100% GA Medicaid fee schedule for outpatient setting,$17.07 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$26.97 ,100% BCBS PPO fee schedule for outpatient setting,$54.86 ,90% of billed charges for outpatient setting,$22.28 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$48.77 ,80% of billed charges for outpatient setting,$45.72 ,75% of billed charges for outpatient setting,$17.24 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$21.42 ,100% GA Medicaid fee schedule for outpatient setting,$17.07 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$57.91 ,95% of billed charges for outpatient setting,$21.85 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$51.82 ,85% of billed charges for outpatient setting,$36.58 ,60% of billed charges for outpatient setting,$17.07 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$36.58 ,60% of billed charges for outpatient setting,$21.85 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$17.07 ,$57.91 ,$39.62 
Outpatient Medical Services,LAB,82977,GGT,301,$59.04 ,$39.56 ,67% of billed charges for outpatient setting,$16.53 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$6.35 ,100% GA Medicaid fee schedule for outpatient setting,$16.53 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$9.90 ,100% BCBS PPO fee schedule for outpatient setting,$53.14 ,90% of billed charges for outpatient setting,$6.60 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$47.23 ,80% of billed charges for outpatient setting,$44.28 ,75% of billed charges for outpatient setting,$16.70 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$6.35 ,100% GA Medicaid fee schedule for outpatient setting,$16.53 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$56.09 ,95% of billed charges for outpatient setting,$6.48 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$50.18 ,85% of billed charges for outpatient setting,$35.42 ,60% of billed charges for outpatient setting,$16.53 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$35.42 ,60% of billed charges for outpatient setting,$6.48 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$6.35 ,$56.09 ,$38.38 
Outpatient Medical Services,LAB,87506,GI PATHOGEN PANEL,301,$395.04 ,$264.68 ,67% of billed charges for outpatient setting,$110.61 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$210.39 ,100% GA Medicaid fee schedule for outpatient setting,$110.61 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$288.38 ,73% of billed charges for outpatient setting,$355.54 ,90% of billed charges for outpatient setting,$218.81 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$316.03 ,80% of billed charges for outpatient setting,$296.28 ,75% of billed charges for outpatient setting,$111.72 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$210.39 ,100% GA Medicaid fee schedule for outpatient setting,$110.61 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$375.29 ,95% of billed charges for outpatient setting,$214.60 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$335.78 ,85% of billed charges for outpatient setting,$237.02 ,60% of billed charges for outpatient setting,$110.61 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$237.02 ,60% of billed charges for outpatient setting,$214.60 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$110.61 ,$375.29 ,$256.78 
Outpatient Medical Services,LAB,87329,GIARDIA ANTIGEN,306,$166.18 ,$111.34 ,67% of billed charges for outpatient setting,$46.53 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,$46.53 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.49 ,100% BCBS PPO fee schedule for outpatient setting,$149.56 ,90% of billed charges for outpatient setting,$15.68 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$132.94 ,80% of billed charges for outpatient setting,$124.64 ,75% of billed charges for outpatient setting,$47.00 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,$46.53 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$157.87 ,95% of billed charges for outpatient setting,$15.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$141.25 ,85% of billed charges for outpatient setting,$99.71 ,60% of billed charges for outpatient setting,$46.53 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$99.71 ,60% of billed charges for outpatient setting,$15.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$15.08 ,$157.87 ,$108.02 
Outpatient Medical Services,LAB,83516,GLIADIN AB (IgA),301,$291.00 ,$194.97 ,67% of billed charges for outpatient setting,$81.48 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$13.45 ,100% GA Medicaid fee schedule for outpatient setting,$81.48 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$14.69 ,100% BCBS PPO fee schedule for outpatient setting,$261.90 ,90% of billed charges for outpatient setting,$13.99 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$232.80 ,80% of billed charges for outpatient setting,$218.25 ,75% of billed charges for outpatient setting,$82.29 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$13.45 ,100% GA Medicaid fee schedule for outpatient setting,$81.48 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$276.45 ,95% of billed charges for outpatient setting,$13.72 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$247.35 ,85% of billed charges for outpatient setting,$174.60 ,60% of billed charges for outpatient setting,$81.48 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$174.60 ,60% of billed charges for outpatient setting,$13.72 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$13.45 ,$276.45 ,$189.15 
Outpatient Medical Services,LAB,82962,GLUCOSE MONITORING,301,$13.92 ,$9.33 ,67% of billed charges for outpatient setting,$3.90 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$2.94 ,100% GA Medicaid fee schedule for outpatient setting,$3.90 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$3.22 ,100% BCBS PPO fee schedule for outpatient setting,$12.53 ,90% of billed charges for outpatient setting,$3.06 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$11.14 ,80% of billed charges for outpatient setting,$10.44 ,75% of billed charges for outpatient setting,$3.94 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$2.94 ,100% GA Medicaid fee schedule for outpatient setting,$3.90 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$13.22 ,95% of billed charges for outpatient setting,$3.00 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$11.83 ,85% of billed charges for outpatient setting,$8.35 ,60% of billed charges for outpatient setting,$3.90 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$8.35 ,60% of billed charges for outpatient setting,$3.00 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$2.94 ,$13.22 ,$9.05 
Outpatient Medical Services,LAB,82947,GLUCOSE SERUM,301,$80.70 ,$54.07 ,67% of billed charges for outpatient setting,$22.60 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$4.93 ,100% GA Medicaid fee schedule for outpatient setting,$22.60 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$5.39 ,100% BCBS PPO fee schedule for outpatient setting,$72.63 ,90% of billed charges for outpatient setting,$5.13 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$64.56 ,80% of billed charges for outpatient setting,$60.53 ,75% of billed charges for outpatient setting,$22.82 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$4.93 ,100% GA Medicaid fee schedule for outpatient setting,$22.60 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$76.67 ,95% of billed charges for outpatient setting,$5.03 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$68.60 ,85% of billed charges for outpatient setting,$48.42 ,60% of billed charges for outpatient setting,$22.60 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$48.42 ,60% of billed charges for outpatient setting,$5.03 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$4.93 ,$76.67 ,$52.46 
Outpatient Medical Services,LAB,87205,GRAM STAIN,300,$30.99 ,$20.76 ,67% of billed charges for outpatient setting,$8.68 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$2.95 ,100% GA Medicaid fee schedule for outpatient setting,$8.68 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$3.22 ,100% BCBS PPO fee schedule for outpatient setting,$27.89 ,90% of billed charges for outpatient setting,$3.07 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$24.79 ,80% of billed charges for outpatient setting,$23.24 ,75% of billed charges for outpatient setting,$8.76 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$2.95 ,100% GA Medicaid fee schedule for outpatient setting,$8.68 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$29.44 ,95% of billed charges for outpatient setting,$3.01 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$26.34 ,85% of billed charges for outpatient setting,$18.59 ,60% of billed charges for outpatient setting,$8.68 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$18.59 ,60% of billed charges for outpatient setting,$3.01 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$2.95 ,$29.44 ,$20.14 
Outpatient Medical Services,LAB,86677,"H PYLORI AB, IGG",302,$82.56 ,$55.32 ,67% of billed charges for outpatient setting,$23.12 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$18.25 ,100% GA Medicaid fee schedule for outpatient setting,$23.12 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$19.95 ,100% BCBS PPO fee schedule for outpatient setting,$74.30 ,90% of billed charges for outpatient setting,$18.98 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$66.05 ,80% of billed charges for outpatient setting,$61.92 ,75% of billed charges for outpatient setting,$23.35 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$18.25 ,100% GA Medicaid fee schedule for outpatient setting,$23.12 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$78.43 ,95% of billed charges for outpatient setting,$18.62 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$70.18 ,85% of billed charges for outpatient setting,$49.54 ,60% of billed charges for outpatient setting,$23.12 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$49.54 ,60% of billed charges for outpatient setting,$18.62 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$18.25 ,$78.43 ,$53.66 
Outpatient Medical Services,LAB,83014,H PYLORI UBT DRUG ADMINISTRATION,301,$48.62 ,$32.58 ,67% of billed charges for outpatient setting,$13.61 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$7.76 ,100% GA Medicaid fee schedule for outpatient setting,$13.61 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$10.81 ,100% BCBS PPO fee schedule for outpatient setting,$43.76 ,90% of billed charges for outpatient setting,$8.07 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$38.90 ,80% of billed charges for outpatient setting,$36.47 ,75% of billed charges for outpatient setting,$13.75 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$7.76 ,100% GA Medicaid fee schedule for outpatient setting,$13.61 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$46.19 ,95% of billed charges for outpatient setting,$7.92 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$41.33 ,85% of billed charges for outpatient setting,$29.17 ,60% of billed charges for outpatient setting,$13.61 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$29.17 ,60% of billed charges for outpatient setting,$7.92 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$7.76 ,$46.19 ,$31.60 
Outpatient Medical Services,LAB,83013,H PYLORI UREA BREATH TEST ANALYSIS,301,$427.50 ,$286.43 ,67% of billed charges for outpatient setting,$119.70 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$66.53 ,100% GA Medicaid fee schedule for outpatient setting,$119.70 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$92.59 ,100% BCBS PPO fee schedule for outpatient setting,$384.75 ,90% of billed charges for outpatient setting,$69.19 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$342.00 ,80% of billed charges for outpatient setting,$320.63 ,75% of billed charges for outpatient setting,$120.90 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$66.53 ,100% GA Medicaid fee schedule for outpatient setting,$119.70 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$406.13 ,95% of billed charges for outpatient setting,$67.86 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$363.38 ,85% of billed charges for outpatient setting,$256.50 ,60% of billed charges for outpatient setting,$119.70 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$256.50 ,60% of billed charges for outpatient setting,$67.86 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$66.53 ,$406.13 ,$277.88 
Outpatient Medical Services,LAB,83010,HAPTOGLOBIN,301,$280.28 ,$187.79 ,67% of billed charges for outpatient setting,$78.48 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$4.69 ,100% GA Medicaid fee schedule for outpatient setting,$78.48 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$5.12 ,100% BCBS PPO fee schedule for outpatient setting,$252.25 ,90% of billed charges for outpatient setting,$4.88 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$224.22 ,80% of billed charges for outpatient setting,$210.21 ,75% of billed charges for outpatient setting,$79.26 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$4.69 ,100% GA Medicaid fee schedule for outpatient setting,$78.48 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$266.27 ,95% of billed charges for outpatient setting,$4.78 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$238.24 ,85% of billed charges for outpatient setting,$168.17 ,60% of billed charges for outpatient setting,$78.48 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$168.17 ,60% of billed charges for outpatient setting,$4.78 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$4.69 ,$266.27 ,$182.18 
Outpatient Medical Services,LAB,84702,HCG QUANTITATIVE,301,$175.89 ,$117.85 ,67% of billed charges for outpatient setting,$49.25 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$8.07 ,100% GA Medicaid fee schedule for outpatient setting,$49.25 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$8.82 ,100% BCBS PPO fee schedule for outpatient setting,$158.30 ,90% of billed charges for outpatient setting,$8.39 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$140.71 ,80% of billed charges for outpatient setting,$131.92 ,75% of billed charges for outpatient setting,$49.74 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$8.07 ,100% GA Medicaid fee schedule for outpatient setting,$49.25 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$167.10 ,95% of billed charges for outpatient setting,$8.23 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$149.51 ,85% of billed charges for outpatient setting,$105.53 ,60% of billed charges for outpatient setting,$49.25 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$105.53 ,60% of billed charges for outpatient setting,$8.23 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$8.07 ,$167.10 ,$114.33 
Outpatient Medical Services,LAB,84703,HCG SERUM QUAL,301,$202.99 ,$136.00 ,67% of billed charges for outpatient setting,$56.84 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$8.07 ,100% GA Medicaid fee schedule for outpatient setting,$56.84 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$8.82 ,100% BCBS PPO fee schedule for outpatient setting,$182.69 ,90% of billed charges for outpatient setting,$8.39 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$162.39 ,80% of billed charges for outpatient setting,$152.24 ,75% of billed charges for outpatient setting,$57.41 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$8.07 ,100% GA Medicaid fee schedule for outpatient setting,$56.84 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$192.84 ,95% of billed charges for outpatient setting,$8.23 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$172.54 ,85% of billed charges for outpatient setting,$121.79 ,60% of billed charges for outpatient setting,$56.84 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$121.79 ,60% of billed charges for outpatient setting,$8.23 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$8.07 ,$192.84 ,$131.94 
Outpatient Medical Services,LAB,81025,HCG URINE QUAL,307,$46.50 ,$31.16 ,67% of billed charges for outpatient setting,$13.02 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$7.96 ,100% GA Medicaid fee schedule for outpatient setting,$13.02 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$8.70 ,100% BCBS PPO fee schedule for outpatient setting,$41.85 ,90% of billed charges for outpatient setting,$8.28 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$37.20 ,80% of billed charges for outpatient setting,$34.88 ,75% of billed charges for outpatient setting,$13.15 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$7.96 ,100% GA Medicaid fee schedule for outpatient setting,$13.02 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$44.18 ,95% of billed charges for outpatient setting,$8.12 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$39.53 ,85% of billed charges for outpatient setting,$27.90 ,60% of billed charges for outpatient setting,$13.02 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$27.90 ,60% of billed charges for outpatient setting,$8.12 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$7.96 ,$44.18 ,$30.23 
Outpatient Medical Services,LAB,85014,HEMATOCRIT,305,$23.36 ,$15.65 ,67% of billed charges for outpatient setting,$6.54 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$2.98 ,100% GA Medicaid fee schedule for outpatient setting,$6.54 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$3.26 ,100% BCBS PPO fee schedule for outpatient setting,$21.02 ,90% of billed charges for outpatient setting,$3.10 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$18.69 ,80% of billed charges for outpatient setting,$17.52 ,75% of billed charges for outpatient setting,$6.61 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$2.98 ,100% GA Medicaid fee schedule for outpatient setting,$6.54 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$22.19 ,95% of billed charges for outpatient setting,$3.04 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$19.86 ,85% of billed charges for outpatient setting,$14.02 ,60% of billed charges for outpatient setting,$6.54 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$14.02 ,60% of billed charges for outpatient setting,$3.04 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$2.98 ,$22.19 ,$15.18 
Outpatient Medical Services,LAB,85018,HEMOGLOBIN,305,$22.91 ,$15.35 ,67% of billed charges for outpatient setting,$6.41 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$2.98 ,100% GA Medicaid fee schedule for outpatient setting,$6.41 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$3.26 ,100% BCBS PPO fee schedule for outpatient setting,$20.62 ,90% of billed charges for outpatient setting,$3.10 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$18.33 ,80% of billed charges for outpatient setting,$17.18 ,75% of billed charges for outpatient setting,$6.48 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$2.98 ,100% GA Medicaid fee schedule for outpatient setting,$6.41 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$21.76 ,95% of billed charges for outpatient setting,$3.04 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$19.47 ,85% of billed charges for outpatient setting,$13.75 ,60% of billed charges for outpatient setting,$6.41 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$13.75 ,60% of billed charges for outpatient setting,$3.04 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$2.98 ,$21.76 ,$14.89 
Outpatient Medical Services,LAB,83036,HEMOGLOBIN A1C,301,$58.56 ,$39.24 ,67% of billed charges for outpatient setting,$16.40 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$12.20 ,100% GA Medicaid fee schedule for outpatient setting,$16.40 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$13.34 ,100% BCBS PPO fee schedule for outpatient setting,$52.70 ,90% of billed charges for outpatient setting,$12.69 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$46.85 ,80% of billed charges for outpatient setting,$43.92 ,75% of billed charges for outpatient setting,$16.56 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$12.20 ,100% GA Medicaid fee schedule for outpatient setting,$16.40 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$55.63 ,95% of billed charges for outpatient setting,$12.44 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$49.78 ,85% of billed charges for outpatient setting,$35.14 ,60% of billed charges for outpatient setting,$16.40 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$35.14 ,60% of billed charges for outpatient setting,$12.44 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$12.20 ,$55.63 ,$38.06 
Outpatient Medical Services,LAB,85027,HEMOGRAM-CHARGE ONLY,305,$118.69 ,$79.52 ,67% of billed charges for outpatient setting,$33.23 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$8.14 ,100% GA Medicaid fee schedule for outpatient setting,$33.23 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$8.89 ,100% BCBS PPO fee schedule for outpatient setting,$106.82 ,90% of billed charges for outpatient setting,$8.47 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$94.95 ,80% of billed charges for outpatient setting,$89.02 ,75% of billed charges for outpatient setting,$33.57 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$8.14 ,100% GA Medicaid fee schedule for outpatient setting,$33.23 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$112.76 ,95% of billed charges for outpatient setting,$8.30 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$100.89 ,85% of billed charges for outpatient setting,$71.21 ,60% of billed charges for outpatient setting,$33.23 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$71.21 ,60% of billed charges for outpatient setting,$8.30 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$8.14 ,$112.76 ,$77.15 
Outpatient Medical Services,LAB,80076,HEPATIC FUNCTION PANEL,301,$192.51 ,$128.98 ,67% of billed charges for outpatient setting,$53.90 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$10.28 ,100% GA Medicaid fee schedule for outpatient setting,$53.90 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$11.23 ,100% BCBS PPO fee schedule for outpatient setting,$173.26 ,90% of billed charges for outpatient setting,$10.69 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$154.01 ,80% of billed charges for outpatient setting,$144.38 ,75% of billed charges for outpatient setting,$54.44 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$10.28 ,100% GA Medicaid fee schedule for outpatient setting,$53.90 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$182.88 ,95% of billed charges for outpatient setting,$10.49 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$163.63 ,85% of billed charges for outpatient setting,$115.51 ,60% of billed charges for outpatient setting,$53.90 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$115.51 ,60% of billed charges for outpatient setting,$10.49 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$10.28 ,$182.88 ,$125.13 
Outpatient Medical Services,LAB,86706,HEPATITIS B SURFACE ANTIBODY,302,$168.74 ,$113.06 ,67% of billed charges for outpatient setting,$47.25 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$13.51 ,100% GA Medicaid fee schedule for outpatient setting,$47.25 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$14.76 ,100% BCBS PPO fee schedule for outpatient setting,$151.87 ,90% of billed charges for outpatient setting,$14.05 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$134.99 ,80% of billed charges for outpatient setting,$126.56 ,75% of billed charges for outpatient setting,$47.72 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$13.51 ,100% GA Medicaid fee schedule for outpatient setting,$47.25 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$160.30 ,95% of billed charges for outpatient setting,$13.78 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$143.43 ,85% of billed charges for outpatient setting,$101.24 ,60% of billed charges for outpatient setting,$47.25 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$101.24 ,60% of billed charges for outpatient setting,$13.78 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$13.51 ,$160.30 ,$109.68 
Outpatient Medical Services,LAB,87340,HEPATITIS B SURFACE ANTIGEN,306,$181.44 ,$121.56 ,67% of billed charges for outpatient setting,$50.80 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$12.99 ,100% GA Medicaid fee schedule for outpatient setting,$50.80 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$14.20 ,100% BCBS PPO fee schedule for outpatient setting,$163.30 ,90% of billed charges for outpatient setting,$13.51 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$145.15 ,80% of billed charges for outpatient setting,$136.08 ,75% of billed charges for outpatient setting,$51.31 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$12.99 ,100% GA Medicaid fee schedule for outpatient setting,$50.80 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$172.37 ,95% of billed charges for outpatient setting,$13.25 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$154.22 ,85% of billed charges for outpatient setting,$108.86 ,60% of billed charges for outpatient setting,$50.80 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$108.86 ,60% of billed charges for outpatient setting,$13.25 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$12.99 ,$172.37 ,$117.94 
Outpatient Medical Services,LAB,86803,HEPATITIS C ANTIBODY,302,$273.73 ,$183.40 ,67% of billed charges for outpatient setting,$76.64 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$10.00 ,100% GA Medicaid fee schedule for outpatient setting,$76.64 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$19.62 ,100% BCBS PPO fee schedule for outpatient setting,$246.36 ,90% of billed charges for outpatient setting,$10.40 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$218.98 ,80% of billed charges for outpatient setting,$205.30 ,75% of billed charges for outpatient setting,$77.41 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$10.00 ,100% GA Medicaid fee schedule for outpatient setting,$76.64 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$260.04 ,95% of billed charges for outpatient setting,$10.20 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$232.67 ,85% of billed charges for outpatient setting,$164.24 ,60% of billed charges for outpatient setting,$76.64 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$164.24 ,60% of billed charges for outpatient setting,$10.20 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$10.00 ,$260.04 ,$177.92 
Outpatient Medical Services,LAB,87522,HEPATITIS C QUANTITATIVE PCR,306,$718.45 ,$481.36 ,67% of billed charges for outpatient setting,$201.17 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$53.87 ,100% GA Medicaid fee schedule for outpatient setting,$201.17 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$58.88 ,100% BCBS PPO fee schedule for outpatient setting,$646.61 ,90% of billed charges for outpatient setting,$56.02 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$574.76 ,80% of billed charges for outpatient setting,$538.84 ,75% of billed charges for outpatient setting,$203.18 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$53.87 ,100% GA Medicaid fee schedule for outpatient setting,$201.17 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$682.53 ,95% of billed charges for outpatient setting,$54.95 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$610.68 ,85% of billed charges for outpatient setting,$431.07 ,60% of billed charges for outpatient setting,$201.17 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$431.07 ,60% of billed charges for outpatient setting,$54.95 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$53.87 ,$682.53 ,$466.99 
Outpatient Medical Services,LAB,80074,HEPATITIS PANEL ACUTE,301,$639.87 ,$428.71 ,67% of billed charges for outpatient setting,$179.16 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$59.89 ,100% GA Medicaid fee schedule for outpatient setting,$179.16 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$65.47 ,100% BCBS PPO fee schedule for outpatient setting,$575.88 ,90% of billed charges for outpatient setting,$62.29 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$511.90 ,80% of billed charges for outpatient setting,$479.90 ,75% of billed charges for outpatient setting,$180.96 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$59.89 ,100% GA Medicaid fee schedule for outpatient setting,$179.16 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$607.88 ,95% of billed charges for outpatient setting,$61.09 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$543.89 ,85% of billed charges for outpatient setting,$383.92 ,60% of billed charges for outpatient setting,$179.16 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$383.92 ,60% of billed charges for outpatient setting,$61.09 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$59.89 ,$607.88 ,$415.92 
Outpatient Medical Services,LAB,88313,HISTOLOGY STAIN GROUP II,312,$142.56 ,$95.52 ,67% of billed charges for outpatient setting,$39.92 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$44.91 ,100% GA Medicaid fee schedule for outpatient setting,$39.92 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$104.07 ,73% of billed charges for outpatient setting,$128.30 ,90% of billed charges for outpatient setting,$46.71 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$114.05 ,80% of billed charges for outpatient setting,$106.92 ,75% of billed charges for outpatient setting,$40.32 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$44.91 ,100% GA Medicaid fee schedule for outpatient setting,$39.92 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$135.43 ,95% of billed charges for outpatient setting,$45.81 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$121.18 ,85% of billed charges for outpatient setting,$85.54 ,60% of billed charges for outpatient setting,$39.92 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$85.54 ,60% of billed charges for outpatient setting,$45.81 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$39.92 ,$135.43 ,$92.66 
Outpatient Medical Services,LAB,86703,HIV 1/2,302,$205.92 ,$137.97 ,67% of billed charges for outpatient setting,$57.66 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$14.96 ,100% GA Medicaid fee schedule for outpatient setting,$57.66 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$18.85 ,100% BCBS PPO fee schedule for outpatient setting,$185.33 ,90% of billed charges for outpatient setting,$15.56 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$164.74 ,80% of billed charges for outpatient setting,$154.44 ,75% of billed charges for outpatient setting,$58.23 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$14.96 ,100% GA Medicaid fee schedule for outpatient setting,$57.66 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$195.62 ,95% of billed charges for outpatient setting,$15.26 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$175.03 ,85% of billed charges for outpatient setting,$123.55 ,60% of billed charges for outpatient setting,$57.66 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$123.55 ,60% of billed charges for outpatient setting,$15.26 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$14.96 ,$195.62 ,$133.85 
Outpatient Medical Services,LAB,87624,HPV DNA PROBE HIGH RISK,300,$151.58 ,$101.56 ,67% of billed charges for outpatient setting,$42.44 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$18.25 ,100% GA Medicaid fee schedule for outpatient setting,$42.44 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$110.65 ,73% of billed charges for outpatient setting,$136.42 ,90% of billed charges for outpatient setting,$18.98 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$121.26 ,80% of billed charges for outpatient setting,$113.69 ,75% of billed charges for outpatient setting,$42.87 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$18.25 ,100% GA Medicaid fee schedule for outpatient setting,$42.44 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$144.00 ,95% of billed charges for outpatient setting,$18.62 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$128.84 ,85% of billed charges for outpatient setting,$90.95 ,60% of billed charges for outpatient setting,$42.44 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$90.95 ,60% of billed charges for outpatient setting,$18.62 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$18.25 ,$144.00 ,$98.53 
Outpatient Medical Services,LAB,87077,ID AEROBIC BACTERIA,306,$44.17 ,$29.59 ,67% of billed charges for outpatient setting,$12.37 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$10.16 ,100% GA Medicaid fee schedule for outpatient setting,$12.37 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$11.11 ,100% BCBS PPO fee schedule for outpatient setting,$39.75 ,90% of billed charges for outpatient setting,$10.57 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$35.34 ,80% of billed charges for outpatient setting,$33.13 ,75% of billed charges for outpatient setting,$12.49 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$10.16 ,100% GA Medicaid fee schedule for outpatient setting,$12.37 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$41.96 ,95% of billed charges for outpatient setting,$10.36 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$37.54 ,85% of billed charges for outpatient setting,$26.50 ,60% of billed charges for outpatient setting,$12.37 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$26.50 ,60% of billed charges for outpatient setting,$10.36 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$10.16 ,$41.96 ,$28.71 
Outpatient Medical Services,LAB,88342,IHC 1ST ANTIBODY STAIN PROC,312,$139.20 ,$93.26 ,67% of billed charges for outpatient setting,$38.98 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$71.58 ,100% GA Medicaid fee schedule for outpatient setting,$38.98 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$101.62 ,73% of billed charges for outpatient setting,$125.28 ,90% of billed charges for outpatient setting,$74.44 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$111.36 ,80% of billed charges for outpatient setting,$104.40 ,75% of billed charges for outpatient setting,$39.37 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$71.58 ,100% GA Medicaid fee schedule for outpatient setting,$38.98 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$132.24 ,95% of billed charges for outpatient setting,$73.01 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$118.32 ,85% of billed charges for outpatient setting,$83.52 ,60% of billed charges for outpatient setting,$38.98 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$83.52 ,60% of billed charges for outpatient setting,$73.01 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$38.98 ,$132.24 ,$90.48 
Outpatient Medical Services,LAB,88341,IHC EACH ADDITIONAL ANTIBODY STAIN PROC,312,$168.00 ,$112.56 ,67% of billed charges for outpatient setting,$47.04 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$57.38 ,100% GA Medicaid fee schedule for outpatient setting,$47.04 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$122.64 ,73% of billed charges for outpatient setting,$151.20 ,90% of billed charges for outpatient setting,$59.68 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$134.40 ,80% of billed charges for outpatient setting,$126.00 ,75% of billed charges for outpatient setting,$47.51 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$57.38 ,100% GA Medicaid fee schedule for outpatient setting,$47.04 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$159.60 ,95% of billed charges for outpatient setting,$58.53 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$142.80 ,85% of billed charges for outpatient setting,$100.80 ,60% of billed charges for outpatient setting,$47.04 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$100.80 ,60% of billed charges for outpatient setting,$58.53 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$47.04 ,$159.60 ,$109.20 
Outpatient Medical Services,LAB,86320,"IMMUNOFIXATION, SERUM",302,$180.96 ,$121.24 ,67% of billed charges for outpatient setting,$50.67 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$28.19 ,100% GA Medicaid fee schedule for outpatient setting,$50.67 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$30.81 ,100% BCBS PPO fee schedule for outpatient setting,$162.86 ,90% of billed charges for outpatient setting,$29.32 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$144.77 ,80% of billed charges for outpatient setting,$135.72 ,75% of billed charges for outpatient setting,$51.18 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$28.19 ,100% GA Medicaid fee schedule for outpatient setting,$50.67 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$171.91 ,95% of billed charges for outpatient setting,$28.75 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$153.82 ,85% of billed charges for outpatient setting,$108.58 ,60% of billed charges for outpatient setting,$50.67 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$108.58 ,60% of billed charges for outpatient setting,$28.75 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$28.19 ,$171.91 ,$117.62 
Outpatient Medical Services,LAB,82784,IMMUNOGLOBULIN IgA,301,$189.23 ,$126.78 ,67% of billed charges for outpatient setting,$52.98 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$11.69 ,100% GA Medicaid fee schedule for outpatient setting,$52.98 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$12.78 ,100% BCBS PPO fee schedule for outpatient setting,$170.31 ,90% of billed charges for outpatient setting,$12.16 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$151.38 ,80% of billed charges for outpatient setting,$141.92 ,75% of billed charges for outpatient setting,$53.51 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$11.69 ,100% GA Medicaid fee schedule for outpatient setting,$52.98 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$179.77 ,95% of billed charges for outpatient setting,$11.92 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$160.85 ,85% of billed charges for outpatient setting,$113.54 ,60% of billed charges for outpatient setting,$52.98 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$113.54 ,60% of billed charges for outpatient setting,$11.92 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$11.69 ,$179.77 ,$123.00 
Outpatient Medical Services,LAB,82785,IMMUNOGLOBULIN IgE,301,$227.00 ,$152.09 ,67% of billed charges for outpatient setting,$63.56 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$20.71 ,100% GA Medicaid fee schedule for outpatient setting,$63.56 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$22.64 ,100% BCBS PPO fee schedule for outpatient setting,$204.30 ,90% of billed charges for outpatient setting,$21.54 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$181.60 ,80% of billed charges for outpatient setting,$170.25 ,75% of billed charges for outpatient setting,$64.20 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$20.71 ,100% GA Medicaid fee schedule for outpatient setting,$63.56 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$215.65 ,95% of billed charges for outpatient setting,$21.12 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$192.95 ,85% of billed charges for outpatient setting,$136.20 ,60% of billed charges for outpatient setting,$63.56 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$136.20 ,60% of billed charges for outpatient setting,$21.12 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$20.71 ,$215.65 ,$147.55 
Outpatient Medical Services,LAB,82784,IMMUNOGLOBULIN IgG,301,$189.23 ,$126.78 ,67% of billed charges for outpatient setting,$52.98 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$11.69 ,100% GA Medicaid fee schedule for outpatient setting,$52.98 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$12.78 ,100% BCBS PPO fee schedule for outpatient setting,$170.31 ,90% of billed charges for outpatient setting,$12.16 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$151.38 ,80% of billed charges for outpatient setting,$141.92 ,75% of billed charges for outpatient setting,$53.51 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$11.69 ,100% GA Medicaid fee schedule for outpatient setting,$52.98 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$179.77 ,95% of billed charges for outpatient setting,$11.92 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$160.85 ,85% of billed charges for outpatient setting,$113.54 ,60% of billed charges for outpatient setting,$52.98 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$113.54 ,60% of billed charges for outpatient setting,$11.92 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$11.69 ,$179.77 ,$123.00 
Outpatient Medical Services,LAB,82784,IMMUNOGLOBULIN IgM,301,$189.23 ,$126.78 ,67% of billed charges for outpatient setting,$52.98 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$11.69 ,100% GA Medicaid fee schedule for outpatient setting,$52.98 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$12.78 ,100% BCBS PPO fee schedule for outpatient setting,$170.31 ,90% of billed charges for outpatient setting,$12.16 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$151.38 ,80% of billed charges for outpatient setting,$141.92 ,75% of billed charges for outpatient setting,$53.51 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$11.69 ,100% GA Medicaid fee schedule for outpatient setting,$52.98 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$179.77 ,95% of billed charges for outpatient setting,$11.92 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$160.85 ,85% of billed charges for outpatient setting,$113.54 ,60% of billed charges for outpatient setting,$52.98 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$113.54 ,60% of billed charges for outpatient setting,$11.92 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$11.69 ,$179.77 ,$123.00 
Outpatient Medical Services,LAB,87804,INFLUENZA PANEL,300,$0.00 ,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,N/A,Not separately reimbursable for physician setting,$16.49 ,100% BCBS PPO fee schedule for outpatient setting,N/A,Not separately reimbursable for physician setting,$15.68 ,104% GA Medicaid fee schedule for outpatient setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,N/A,Not separately reimbursable for physician setting,N/A,95% of billed charges for outpatient setting,$15.38 ,102% GA Medicaid fee schedule for outpatient setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,$15.38 ,102% GA Medicaid fee schedule for outpatient setting,$15.08 ,$16.49 ,N/A
Outpatient Medical Services,LAB,87400,INFLUENZA TYPE A,300,$84.00 ,$56.28 ,67% of billed charges for outpatient setting,$23.52 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,$23.52 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.49 ,100% BCBS PPO fee schedule for outpatient setting,$75.60 ,90% of billed charges for outpatient setting,$15.68 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$67.20 ,80% of billed charges for outpatient setting,$63.00 ,75% of billed charges for outpatient setting,$23.76 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,$23.52 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$79.80 ,95% of billed charges for outpatient setting,$15.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$71.40 ,85% of billed charges for outpatient setting,$50.40 ,60% of billed charges for outpatient setting,$23.52 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$50.40 ,60% of billed charges for outpatient setting,$15.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$15.08 ,$79.80 ,$54.60 
Outpatient Medical Services,LAB,87400,INFLUENZA TYPE B,300,$84.00 ,$56.28 ,67% of billed charges for outpatient setting,$23.52 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,$23.52 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.49 ,100% BCBS PPO fee schedule for outpatient setting,$75.60 ,90% of billed charges for outpatient setting,$15.68 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$67.20 ,80% of billed charges for outpatient setting,$63.00 ,75% of billed charges for outpatient setting,$23.76 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,$23.52 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$79.80 ,95% of billed charges for outpatient setting,$15.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$71.40 ,85% of billed charges for outpatient setting,$50.40 ,60% of billed charges for outpatient setting,$23.52 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$50.40 ,60% of billed charges for outpatient setting,$15.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$15.08 ,$79.80 ,$54.60 
Outpatient Medical Services,LAB,83540,IRON,301,$32.07 ,$21.49 ,67% of billed charges for outpatient setting,$8.98 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$8.15 ,100% GA Medicaid fee schedule for outpatient setting,$8.98 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$8.90 ,100% BCBS PPO fee schedule for outpatient setting,$28.86 ,90% of billed charges for outpatient setting,$8.48 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$25.66 ,80% of billed charges for outpatient setting,$24.05 ,75% of billed charges for outpatient setting,$9.07 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$8.15 ,100% GA Medicaid fee schedule for outpatient setting,$8.98 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$30.47 ,95% of billed charges for outpatient setting,$8.31 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$27.26 ,85% of billed charges for outpatient setting,$19.24 ,60% of billed charges for outpatient setting,$8.98 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$19.24 ,60% of billed charges for outpatient setting,$8.31 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$8.15 ,$30.47 ,$20.85 
Outpatient Medical Services,LAB,83883,"KAPPA LIGHT CHAINS, FREE, SERUM",305,$138.71 ,$92.94 ,67% of billed charges for outpatient setting,$38.84 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$17.10 ,100% GA Medicaid fee schedule for outpatient setting,$38.84 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$18.69 ,100% BCBS PPO fee schedule for outpatient setting,$124.84 ,90% of billed charges for outpatient setting,$17.78 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$110.97 ,80% of billed charges for outpatient setting,$104.03 ,75% of billed charges for outpatient setting,$39.23 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$17.10 ,100% GA Medicaid fee schedule for outpatient setting,$38.84 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$131.77 ,95% of billed charges for outpatient setting,$17.44 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$117.90 ,85% of billed charges for outpatient setting,$83.23 ,60% of billed charges for outpatient setting,$38.84 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$83.23 ,60% of billed charges for outpatient setting,$17.44 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$17.10 ,$131.77 ,$90.16 
Outpatient Medical Services,LAB,87210,"KOH PREP, VAGINAL",306,$84.48 ,$56.60 ,67% of billed charges for outpatient setting,$23.65 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$5.36 ,100% GA Medicaid fee schedule for outpatient setting,$23.65 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$5.87 ,100% BCBS PPO fee schedule for outpatient setting,$76.03 ,90% of billed charges for outpatient setting,$5.57 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$67.58 ,80% of billed charges for outpatient setting,$63.36 ,75% of billed charges for outpatient setting,$23.89 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$5.36 ,100% GA Medicaid fee schedule for outpatient setting,$23.65 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$80.26 ,95% of billed charges for outpatient setting,$5.47 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$71.81 ,85% of billed charges for outpatient setting,$50.69 ,60% of billed charges for outpatient setting,$23.65 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$50.69 ,60% of billed charges for outpatient setting,$5.47 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$5.36 ,$80.26 ,$54.91 
Outpatient Medical Services,LAB,83605,LACTIC ACID,301,$69.12 ,$46.31 ,67% of billed charges for outpatient setting,$19.35 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$13.43 ,100% GA Medicaid fee schedule for outpatient setting,$19.35 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$14.68 ,100% BCBS PPO fee schedule for outpatient setting,$62.21 ,90% of billed charges for outpatient setting,$13.97 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$55.30 ,80% of billed charges for outpatient setting,$51.84 ,75% of billed charges for outpatient setting,$19.55 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$13.43 ,100% GA Medicaid fee schedule for outpatient setting,$19.35 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$65.66 ,95% of billed charges for outpatient setting,$13.70 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$58.75 ,85% of billed charges for outpatient setting,$41.47 ,60% of billed charges for outpatient setting,$19.35 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$41.47 ,60% of billed charges for outpatient setting,$13.70 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$13.43 ,$65.66 ,$44.93 
Outpatient Medical Services,LAB,83630,LACTOFERRIN FECAL QUAL,301,$191.22 ,$128.12 ,67% of billed charges for outpatient setting,$53.54 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$13.45 ,100% GA Medicaid fee schedule for outpatient setting,$53.54 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$26.98 ,100% BCBS PPO fee schedule for outpatient setting,$172.10 ,90% of billed charges for outpatient setting,$13.99 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$152.98 ,80% of billed charges for outpatient setting,$143.42 ,75% of billed charges for outpatient setting,$54.08 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$13.45 ,100% GA Medicaid fee schedule for outpatient setting,$53.54 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$181.66 ,95% of billed charges for outpatient setting,$13.72 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$162.54 ,85% of billed charges for outpatient setting,$114.73 ,60% of billed charges for outpatient setting,$53.54 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$114.73 ,60% of billed charges for outpatient setting,$13.72 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$13.45 ,$181.66 ,$124.29 
Outpatient Medical Services,LAB,83883,"LAMBDA LIGHT CHAINS, FREE, SERUM",305,$138.71 ,$92.94 ,67% of billed charges for outpatient setting,$38.84 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$17.10 ,100% GA Medicaid fee schedule for outpatient setting,$38.84 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$18.69 ,100% BCBS PPO fee schedule for outpatient setting,$124.84 ,90% of billed charges for outpatient setting,$17.78 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$110.97 ,80% of billed charges for outpatient setting,$104.03 ,75% of billed charges for outpatient setting,$39.23 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$17.10 ,100% GA Medicaid fee schedule for outpatient setting,$38.84 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$131.77 ,95% of billed charges for outpatient setting,$17.44 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$117.90 ,85% of billed charges for outpatient setting,$83.23 ,60% of billed charges for outpatient setting,$38.84 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$83.23 ,60% of billed charges for outpatient setting,$17.44 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$17.10 ,$131.77 ,$90.16 
Outpatient Medical Services,LAB,83615,LDH,301,$36.60 ,$24.52 ,67% of billed charges for outpatient setting,$10.25 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$6.35 ,100% GA Medicaid fee schedule for outpatient setting,$10.25 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$8.30 ,100% BCBS PPO fee schedule for outpatient setting,$32.94 ,90% of billed charges for outpatient setting,$6.60 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$29.28 ,80% of billed charges for outpatient setting,$27.45 ,75% of billed charges for outpatient setting,$10.35 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$6.35 ,100% GA Medicaid fee schedule for outpatient setting,$10.25 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$34.77 ,95% of billed charges for outpatient setting,$6.48 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$31.11 ,85% of billed charges for outpatient setting,$21.96 ,60% of billed charges for outpatient setting,$10.25 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$21.96 ,60% of billed charges for outpatient setting,$6.48 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$6.35 ,$34.77 ,$23.79 
Outpatient Medical Services,LAB,83655,"LEAD PEDIATRIC, CAPILLARY",301,$111.54 ,$74.73 ,67% of billed charges for outpatient setting,$31.23 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$10.00 ,100% GA Medicaid fee schedule for outpatient setting,$31.23 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.64 ,100% BCBS PPO fee schedule for outpatient setting,$100.39 ,90% of billed charges for outpatient setting,$10.40 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$89.23 ,80% of billed charges for outpatient setting,$83.66 ,75% of billed charges for outpatient setting,$31.54 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$10.00 ,100% GA Medicaid fee schedule for outpatient setting,$31.23 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$105.96 ,95% of billed charges for outpatient setting,$10.20 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$94.81 ,85% of billed charges for outpatient setting,$66.92 ,60% of billed charges for outpatient setting,$31.23 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$66.92 ,60% of billed charges for outpatient setting,$10.20 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$10.00 ,$105.96 ,$72.50 
Outpatient Medical Services,LAB,87449,LEGIONELLA URINARY AG,300,$46.08 ,$30.87 ,67% of billed charges for outpatient setting,$12.90 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,$12.90 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.49 ,100% BCBS PPO fee schedule for outpatient setting,$41.47 ,90% of billed charges for outpatient setting,$15.68 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$36.86 ,80% of billed charges for outpatient setting,$34.56 ,75% of billed charges for outpatient setting,$13.03 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,$12.90 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$43.78 ,95% of billed charges for outpatient setting,$15.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$39.17 ,85% of billed charges for outpatient setting,$27.65 ,60% of billed charges for outpatient setting,$12.90 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$27.65 ,60% of billed charges for outpatient setting,$15.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$12.90 ,$43.78 ,$29.95 
Outpatient Medical Services,LAB,83002,LH,301,$250.89 ,$168.10 ,67% of billed charges for outpatient setting,$70.25 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$23.29 ,100% GA Medicaid fee schedule for outpatient setting,$70.25 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$25.46 ,100% BCBS PPO fee schedule for outpatient setting,$225.80 ,90% of billed charges for outpatient setting,$24.22 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$200.71 ,80% of billed charges for outpatient setting,$188.17 ,75% of billed charges for outpatient setting,$70.95 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$23.29 ,100% GA Medicaid fee schedule for outpatient setting,$70.25 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$238.35 ,95% of billed charges for outpatient setting,$23.76 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$213.26 ,85% of billed charges for outpatient setting,$150.53 ,60% of billed charges for outpatient setting,$70.25 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$150.53 ,60% of billed charges for outpatient setting,$23.76 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$23.29 ,$238.35 ,$163.08 
Outpatient Medical Services,LAB,83690,LIPASE,301,$49.00 ,$32.83 ,67% of billed charges for outpatient setting,$13.72 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$8.66 ,100% GA Medicaid fee schedule for outpatient setting,$13.72 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$9.47 ,100% BCBS PPO fee schedule for outpatient setting,$44.10 ,90% of billed charges for outpatient setting,$9.01 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$39.20 ,80% of billed charges for outpatient setting,$36.75 ,75% of billed charges for outpatient setting,$13.86 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$8.66 ,100% GA Medicaid fee schedule for outpatient setting,$13.72 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$46.55 ,95% of billed charges for outpatient setting,$8.83 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$41.65 ,85% of billed charges for outpatient setting,$29.40 ,60% of billed charges for outpatient setting,$13.72 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$29.40 ,60% of billed charges for outpatient setting,$8.83 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$8.66 ,$46.55 ,$31.85 
Outpatient Medical Services,LAB,80061,LIPID PANEL,301,$95.00 ,$63.65 ,67% of billed charges for outpatient setting,$26.60 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.85 ,100% GA Medicaid fee schedule for outpatient setting,$26.60 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$18.42 ,100% BCBS PPO fee schedule for outpatient setting,$85.50 ,90% of billed charges for outpatient setting,$17.52 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$76.00 ,80% of billed charges for outpatient setting,$71.25 ,75% of billed charges for outpatient setting,$26.87 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$16.85 ,100% GA Medicaid fee schedule for outpatient setting,$26.60 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$90.25 ,95% of billed charges for outpatient setting,$17.19 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$80.75 ,85% of billed charges for outpatient setting,$57.00 ,60% of billed charges for outpatient setting,$26.60 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$57.00 ,60% of billed charges for outpatient setting,$17.19 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$16.85 ,$90.25 ,$61.75 
Outpatient Medical Services,LAB,83735,MAGNESIUM,301,$59.04 ,$39.56 ,67% of billed charges for outpatient setting,$16.53 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$8.42 ,100% GA Medicaid fee schedule for outpatient setting,$16.53 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$9.21 ,100% BCBS PPO fee schedule for outpatient setting,$53.14 ,90% of billed charges for outpatient setting,$8.76 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$47.23 ,80% of billed charges for outpatient setting,$44.28 ,75% of billed charges for outpatient setting,$16.70 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$8.42 ,100% GA Medicaid fee schedule for outpatient setting,$16.53 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$56.09 ,95% of billed charges for outpatient setting,$8.59 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$50.18 ,85% of billed charges for outpatient setting,$35.42 ,60% of billed charges for outpatient setting,$16.53 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$35.42 ,60% of billed charges for outpatient setting,$8.59 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$8.42 ,$56.09 ,$38.38 
Outpatient Medical Services,LAB,85007,MANUAL DIFF,,$8.64 ,$5.79 ,67% of billed charges for outpatient setting,$2.42 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$4.33 ,100% GA Medicaid fee schedule for outpatient setting,$2.42 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$4.73 ,100% BCBS PPO fee schedule for outpatient setting,$7.78 ,90% of billed charges for outpatient setting,$4.50 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$6.91 ,80% of billed charges for outpatient setting,$6.48 ,75% of billed charges for outpatient setting,$2.44 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$4.33 ,100% GA Medicaid fee schedule for outpatient setting,$2.42 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$8.21 ,95% of billed charges for outpatient setting,$4.42 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$7.34 ,85% of billed charges for outpatient setting,$5.18 ,60% of billed charges for outpatient setting,$2.42 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$5.18 ,60% of billed charges for outpatient setting,$4.42 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$2.42 ,$8.21 ,$5.62 
Outpatient Medical Services,LAB,86765,"MEASLES ANTIBODY, IGG",370,$147.17 ,$98.60 ,67% of billed charges for outpatient setting,$41.21 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.20 ,100% GA Medicaid fee schedule for outpatient setting,$41.21 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$17.71 ,100% BCBS PPO fee schedule for outpatient setting,$132.45 ,90% of billed charges for outpatient setting,$16.85 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$117.74 ,80% of billed charges for outpatient setting,$110.38 ,75% of billed charges for outpatient setting,$41.62 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$16.20 ,100% GA Medicaid fee schedule for outpatient setting,$41.21 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$139.81 ,95% of billed charges for outpatient setting,$16.52 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$125.09 ,85% of billed charges for outpatient setting,$88.30 ,60% of billed charges for outpatient setting,$41.21 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$88.30 ,60% of billed charges for outpatient setting,$16.52 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$16.20 ,$139.81 ,$95.66 
Outpatient Medical Services,LAB,87186,MIC SENSITIVITY,306,$50.40 ,$33.77 ,67% of billed charges for outpatient setting,$14.11 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$10.87 ,100% GA Medicaid fee schedule for outpatient setting,$14.11 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$11.88 ,100% BCBS PPO fee schedule for outpatient setting,$45.36 ,90% of billed charges for outpatient setting,$11.30 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$40.32 ,80% of billed charges for outpatient setting,$37.80 ,75% of billed charges for outpatient setting,$14.25 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$10.87 ,100% GA Medicaid fee schedule for outpatient setting,$14.11 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$47.88 ,95% of billed charges for outpatient setting,$11.09 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$42.84 ,85% of billed charges for outpatient setting,$30.24 ,60% of billed charges for outpatient setting,$14.11 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$30.24 ,60% of billed charges for outpatient setting,$11.09 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$10.87 ,$47.88 ,$32.76 
Outpatient Medical Services,LAB,82043,MICROALBUMIN URINE,301,$113.06 ,$75.75 ,67% of billed charges for outpatient setting,$31.66 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$7.28 ,100% GA Medicaid fee schedule for outpatient setting,$31.66 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$7.95 ,100% BCBS PPO fee schedule for outpatient setting,$101.75 ,90% of billed charges for outpatient setting,$7.57 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$90.45 ,80% of billed charges for outpatient setting,$84.80 ,75% of billed charges for outpatient setting,$31.97 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$7.28 ,100% GA Medicaid fee schedule for outpatient setting,$31.66 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$107.41 ,95% of billed charges for outpatient setting,$7.43 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$96.10 ,85% of billed charges for outpatient setting,$67.84 ,60% of billed charges for outpatient setting,$31.66 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$67.84 ,60% of billed charges for outpatient setting,$7.43 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$7.28 ,$107.41 ,$73.49 
Outpatient Medical Services,LAB,86308,MONOSPOT,300,$151.85 ,$101.74 ,67% of billed charges for outpatient setting,$42.52 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$6.51 ,100% GA Medicaid fee schedule for outpatient setting,$42.52 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$7.11 ,100% BCBS PPO fee schedule for outpatient setting,$136.67 ,90% of billed charges for outpatient setting,$6.77 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$121.48 ,80% of billed charges for outpatient setting,$113.89 ,75% of billed charges for outpatient setting,$42.94 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$6.51 ,100% GA Medicaid fee schedule for outpatient setting,$42.52 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$144.26 ,95% of billed charges for outpatient setting,$6.64 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$129.07 ,85% of billed charges for outpatient setting,$91.11 ,60% of billed charges for outpatient setting,$42.52 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$91.11 ,60% of billed charges for outpatient setting,$6.64 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$6.51 ,$144.26 ,$98.70 
Outpatient Medical Services,LAB,88361,MORPHOMETRIC ANALYSIS COMP ASST,312,$373.44 ,$250.20 ,67% of billed charges for outpatient setting,$104.56 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$122.28 ,100% GA Medicaid fee schedule for outpatient setting,$104.56 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$272.61 ,73% of billed charges for outpatient setting,$336.10 ,90% of billed charges for outpatient setting,$127.17 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$298.75 ,80% of billed charges for outpatient setting,$280.08 ,75% of billed charges for outpatient setting,$105.61 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$122.28 ,100% GA Medicaid fee schedule for outpatient setting,$104.56 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$354.77 ,95% of billed charges for outpatient setting,$124.73 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$317.42 ,85% of billed charges for outpatient setting,$224.06 ,60% of billed charges for outpatient setting,$104.56 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$224.06 ,60% of billed charges for outpatient setting,$124.73 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$104.56 ,$354.77 ,$242.74 
Outpatient Medical Services,LAB,87641,MRSA AMPLIFIED PROBE TECHNIQUE,306,$256.30 ,$171.72 ,67% of billed charges for outpatient setting,$71.76 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$24.67 ,100% GA Medicaid fee schedule for outpatient setting,$71.76 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$26.97 ,100% BCBS PPO fee schedule for outpatient setting,$230.67 ,90% of billed charges for outpatient setting,$25.66 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$205.04 ,80% of billed charges for outpatient setting,$192.23 ,75% of billed charges for outpatient setting,$72.48 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$24.67 ,100% GA Medicaid fee schedule for outpatient setting,$71.76 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$243.49 ,95% of billed charges for outpatient setting,$25.16 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$217.86 ,85% of billed charges for outpatient setting,$153.78 ,60% of billed charges for outpatient setting,$71.76 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$153.78 ,60% of billed charges for outpatient setting,$25.16 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$24.67 ,$243.49 ,$166.60 
Outpatient Medical Services,LAB,86735,"MUMPS AB, IGG",302,$97.20 ,$65.12 ,67% of billed charges for outpatient setting,$27.22 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.41 ,100% GA Medicaid fee schedule for outpatient setting,$27.22 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$17.94 ,100% BCBS PPO fee schedule for outpatient setting,$87.48 ,90% of billed charges for outpatient setting,$17.07 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$77.76 ,80% of billed charges for outpatient setting,$72.90 ,75% of billed charges for outpatient setting,$27.49 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$16.41 ,100% GA Medicaid fee schedule for outpatient setting,$27.22 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$92.34 ,95% of billed charges for outpatient setting,$16.74 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$82.62 ,85% of billed charges for outpatient setting,$58.32 ,60% of billed charges for outpatient setting,$27.22 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$58.32 ,60% of billed charges for outpatient setting,$16.74 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$16.41 ,$92.34 ,$63.18 
Outpatient Medical Services,LAB,83874,MYOGLOBIN,301,$135.59 ,$90.85 ,67% of billed charges for outpatient setting,$37.97 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.24 ,100% GA Medicaid fee schedule for outpatient setting,$37.97 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$17.75 ,100% BCBS PPO fee schedule for outpatient setting,$122.03 ,90% of billed charges for outpatient setting,$16.89 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$108.47 ,80% of billed charges for outpatient setting,$101.69 ,75% of billed charges for outpatient setting,$38.34 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$16.24 ,100% GA Medicaid fee schedule for outpatient setting,$37.97 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$128.81 ,95% of billed charges for outpatient setting,$16.56 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$115.25 ,85% of billed charges for outpatient setting,$81.35 ,60% of billed charges for outpatient setting,$37.97 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$81.35 ,60% of billed charges for outpatient setting,$16.56 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$16.24 ,$128.81 ,$88.13 
Outpatient Medical Services,LAB,87177,O&P CONCENTRATION,306,$70.68 ,$47.36 ,67% of billed charges for outpatient setting,$19.79 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$11.19 ,100% GA Medicaid fee schedule for outpatient setting,$19.79 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$12.23 ,100% BCBS PPO fee schedule for outpatient setting,$63.61 ,90% of billed charges for outpatient setting,$11.64 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$56.54 ,80% of billed charges for outpatient setting,$53.01 ,75% of billed charges for outpatient setting,$19.99 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$11.19 ,100% GA Medicaid fee schedule for outpatient setting,$19.79 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$67.15 ,95% of billed charges for outpatient setting,$11.41 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$60.08 ,85% of billed charges for outpatient setting,$42.41 ,60% of billed charges for outpatient setting,$19.79 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$42.41 ,60% of billed charges for outpatient setting,$11.41 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$11.19 ,$67.15 ,$45.94 
Outpatient Medical Services,LAB,87177,O&P SCREEN,306,$251.68 ,$168.63 ,67% of billed charges for outpatient setting,$70.47 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$11.19 ,100% GA Medicaid fee schedule for outpatient setting,$70.47 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$12.23 ,100% BCBS PPO fee schedule for outpatient setting,$226.51 ,90% of billed charges for outpatient setting,$11.64 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$201.34 ,80% of billed charges for outpatient setting,$188.76 ,75% of billed charges for outpatient setting,$71.18 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$11.19 ,100% GA Medicaid fee schedule for outpatient setting,$70.47 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$239.10 ,95% of billed charges for outpatient setting,$11.41 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$213.93 ,85% of billed charges for outpatient setting,$151.01 ,60% of billed charges for outpatient setting,$70.47 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$151.01 ,60% of billed charges for outpatient setting,$11.41 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$11.19 ,$239.10 ,$163.59 
Outpatient Medical Services,LAB,87209,O&P TRICHROME,306,$67.20 ,$45.02 ,67% of billed charges for outpatient setting,$18.82 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$22.60 ,100% GA Medicaid fee schedule for outpatient setting,$18.82 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$24.71 ,100% BCBS PPO fee schedule for outpatient setting,$60.48 ,90% of billed charges for outpatient setting,$23.50 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$53.76 ,80% of billed charges for outpatient setting,$50.40 ,75% of billed charges for outpatient setting,$19.00 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$22.60 ,100% GA Medicaid fee schedule for outpatient setting,$18.82 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$63.84 ,95% of billed charges for outpatient setting,$23.05 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$57.12 ,85% of billed charges for outpatient setting,$40.32 ,60% of billed charges for outpatient setting,$18.82 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$40.32 ,60% of billed charges for outpatient setting,$23.05 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$18.82 ,$63.84 ,$43.68 
Outpatient Medical Services,LAB,82272,OCCULT BLOOD STOOL,300,$22.65 ,$15.18 ,67% of billed charges for outpatient setting,$6.34 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$4.04 ,100% GA Medicaid fee schedule for outpatient setting,$6.34 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$4.42 ,100% BCBS PPO fee schedule for outpatient setting,$20.39 ,90% of billed charges for outpatient setting,$4.20 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$18.12 ,80% of billed charges for outpatient setting,$16.99 ,75% of billed charges for outpatient setting,$6.41 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$4.04 ,100% GA Medicaid fee schedule for outpatient setting,$6.34 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$21.52 ,95% of billed charges for outpatient setting,$4.12 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$19.25 ,85% of billed charges for outpatient setting,$13.59 ,60% of billed charges for outpatient setting,$6.34 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$13.59 ,60% of billed charges for outpatient setting,$4.12 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$4.04 ,$21.52 ,$14.72 
Outpatient Medical Services,LAB,83930,"OSMOLALITY, SERUM",301,$80.16 ,$53.71 ,67% of billed charges for outpatient setting,$22.44 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$8.32 ,100% GA Medicaid fee schedule for outpatient setting,$22.44 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$9.09 ,100% BCBS PPO fee schedule for outpatient setting,$72.14 ,90% of billed charges for outpatient setting,$8.65 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$64.13 ,80% of billed charges for outpatient setting,$60.12 ,75% of billed charges for outpatient setting,$22.67 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$8.32 ,100% GA Medicaid fee schedule for outpatient setting,$22.44 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$76.15 ,95% of billed charges for outpatient setting,$8.49 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$68.14 ,85% of billed charges for outpatient setting,$48.10 ,60% of billed charges for outpatient setting,$22.44 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$48.10 ,60% of billed charges for outpatient setting,$8.49 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$8.32 ,$76.15 ,$52.10 
Outpatient Medical Services,LAB,83935,"OSMOLALITY, URINE",301,$88.80 ,$59.50 ,67% of billed charges for outpatient setting,$24.86 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$8.57 ,100% GA Medicaid fee schedule for outpatient setting,$24.86 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$9.37 ,100% BCBS PPO fee schedule for outpatient setting,$79.92 ,90% of billed charges for outpatient setting,$8.91 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$71.04 ,80% of billed charges for outpatient setting,$66.60 ,75% of billed charges for outpatient setting,$25.11 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$8.57 ,100% GA Medicaid fee schedule for outpatient setting,$24.86 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$84.36 ,95% of billed charges for outpatient setting,$8.74 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$75.48 ,85% of billed charges for outpatient setting,$53.28 ,60% of billed charges for outpatient setting,$24.86 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$53.28 ,60% of billed charges for outpatient setting,$8.74 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$8.57 ,$84.36 ,$57.72 
Outpatient Medical Services,LAB,85060,PATHOLOGIST SLIDE REVIEW,305,$178.14 ,$119.35 ,67% of billed charges for outpatient setting,$49.88 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$25.97 ,100% GA Medicaid fee schedule for outpatient setting,$49.88 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$130.04 ,73% of billed charges for outpatient setting,$160.33 ,90% of billed charges for outpatient setting,$27.01 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$142.51 ,80% of billed charges for outpatient setting,$133.61 ,75% of billed charges for outpatient setting,$50.38 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$25.97 ,100% GA Medicaid fee schedule for outpatient setting,$49.88 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$169.23 ,95% of billed charges for outpatient setting,$26.49 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$151.42 ,85% of billed charges for outpatient setting,$106.88 ,60% of billed charges for outpatient setting,$49.88 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$106.88 ,60% of billed charges for outpatient setting,$26.49 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$25.97 ,$169.23 ,$115.79 
Outpatient Medical Services,LAB,80184,PHENOBARBITAL,301,$41.28 ,$27.66 ,67% of billed charges for outpatient setting,$11.56 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$14.41 ,100% GA Medicaid fee schedule for outpatient setting,$11.56 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$15.74 ,100% BCBS PPO fee schedule for outpatient setting,$37.15 ,90% of billed charges for outpatient setting,$14.99 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$33.02 ,80% of billed charges for outpatient setting,$30.96 ,75% of billed charges for outpatient setting,$11.67 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$14.41 ,100% GA Medicaid fee schedule for outpatient setting,$11.56 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$39.22 ,95% of billed charges for outpatient setting,$14.70 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$35.09 ,85% of billed charges for outpatient setting,$24.77 ,60% of billed charges for outpatient setting,$11.56 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$24.77 ,60% of billed charges for outpatient setting,$14.70 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$11.56 ,$39.22 ,$26.83 
Outpatient Medical Services,LAB,80185,PHENYTOIN,301,$48.48 ,$32.48 ,67% of billed charges for outpatient setting,$13.57 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.67 ,100% GA Medicaid fee schedule for outpatient setting,$13.57 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$18.22 ,100% BCBS PPO fee schedule for outpatient setting,$43.63 ,90% of billed charges for outpatient setting,$17.34 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$38.78 ,80% of billed charges for outpatient setting,$36.36 ,75% of billed charges for outpatient setting,$13.71 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$16.67 ,100% GA Medicaid fee schedule for outpatient setting,$13.57 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$46.06 ,95% of billed charges for outpatient setting,$17.00 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$41.21 ,85% of billed charges for outpatient setting,$29.09 ,60% of billed charges for outpatient setting,$13.57 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$29.09 ,60% of billed charges for outpatient setting,$17.00 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$13.57 ,$46.06 ,$31.51 
Outpatient Medical Services,LAB,84100,PHOSPHORUS,301,$34.73 ,$23.27 ,67% of billed charges for outpatient setting,$9.72 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$5.97 ,100% GA Medicaid fee schedule for outpatient setting,$9.72 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$6.52 ,100% BCBS PPO fee schedule for outpatient setting,$31.26 ,90% of billed charges for outpatient setting,$6.21 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$27.78 ,80% of billed charges for outpatient setting,$26.05 ,75% of billed charges for outpatient setting,$9.82 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$5.97 ,100% GA Medicaid fee schedule for outpatient setting,$9.72 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$32.99 ,95% of billed charges for outpatient setting,$6.09 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$29.52 ,85% of billed charges for outpatient setting,$20.84 ,60% of billed charges for outpatient setting,$9.72 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$20.84 ,60% of billed charges for outpatient setting,$6.09 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$5.97 ,$32.99 ,$22.57 
Outpatient Medical Services,LAB,86317,PNEUMOCOCCAL AB EACH SEROTYPE,302,$110.23 ,$73.85 ,67% of billed charges for outpatient setting,$30.86 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$15.09 ,100% GA Medicaid fee schedule for outpatient setting,$30.86 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.50 ,100% BCBS PPO fee schedule for outpatient setting,$99.21 ,90% of billed charges for outpatient setting,$15.69 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$88.18 ,80% of billed charges for outpatient setting,$82.67 ,75% of billed charges for outpatient setting,$31.17 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$15.09 ,100% GA Medicaid fee schedule for outpatient setting,$30.86 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$104.72 ,95% of billed charges for outpatient setting,$15.39 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$93.70 ,85% of billed charges for outpatient setting,$66.14 ,60% of billed charges for outpatient setting,$30.86 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$66.14 ,60% of billed charges for outpatient setting,$15.39 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$15.09 ,$104.72 ,$71.65 
Outpatient Medical Services,LAB,87449,PNEUMOCOCCAL AG URINE,300,$46.08 ,$30.87 ,67% of billed charges for outpatient setting,$12.90 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,$12.90 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.49 ,100% BCBS PPO fee schedule for outpatient setting,$41.47 ,90% of billed charges for outpatient setting,$15.68 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$36.86 ,80% of billed charges for outpatient setting,$34.56 ,75% of billed charges for outpatient setting,$13.03 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,$12.90 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$43.78 ,95% of billed charges for outpatient setting,$15.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$39.17 ,85% of billed charges for outpatient setting,$27.65 ,60% of billed charges for outpatient setting,$12.90 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$27.65 ,60% of billed charges for outpatient setting,$15.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$12.90 ,$43.78 ,$29.95 
Outpatient Medical Services,LAB,84132,POTASSIUM,301,$29.50 ,$19.77 ,67% of billed charges for outpatient setting,$8.26 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$5.78 ,100% GA Medicaid fee schedule for outpatient setting,$8.26 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$6.32 ,100% BCBS PPO fee schedule for outpatient setting,$26.55 ,90% of billed charges for outpatient setting,$6.01 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$23.60 ,80% of billed charges for outpatient setting,$22.13 ,75% of billed charges for outpatient setting,$8.34 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$5.78 ,100% GA Medicaid fee schedule for outpatient setting,$8.26 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$28.03 ,95% of billed charges for outpatient setting,$5.90 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$25.08 ,85% of billed charges for outpatient setting,$17.70 ,60% of billed charges for outpatient setting,$8.26 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$17.70 ,60% of billed charges for outpatient setting,$5.90 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$5.78 ,$28.03 ,$19.18 
Outpatient Medical Services,LAB,84134,PREALBUMIN,301,$96.00 ,$64.32 ,67% of billed charges for outpatient setting,$26.88 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$18.34 ,100% GA Medicaid fee schedule for outpatient setting,$26.88 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$20.05 ,100% BCBS PPO fee schedule for outpatient setting,$86.40 ,90% of billed charges for outpatient setting,$19.07 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$76.80 ,80% of billed charges for outpatient setting,$72.00 ,75% of billed charges for outpatient setting,$27.15 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$18.34 ,100% GA Medicaid fee schedule for outpatient setting,$26.88 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$91.20 ,95% of billed charges for outpatient setting,$18.71 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$81.60 ,85% of billed charges for outpatient setting,$57.60 ,60% of billed charges for outpatient setting,$26.88 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$57.60 ,60% of billed charges for outpatient setting,$18.71 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$18.34 ,$91.20 ,$62.40 
Outpatient Medical Services,LAB,84145,"PROCALCITONIN, SERUM",301,$103.68 ,$69.47 ,67% of billed charges for outpatient setting,$29.03 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$24.06 ,100% GA Medicaid fee schedule for outpatient setting,$29.03 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$36.82 ,100% BCBS PPO fee schedule for outpatient setting,$93.31 ,90% of billed charges for outpatient setting,$25.02 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$82.94 ,80% of billed charges for outpatient setting,$77.76 ,75% of billed charges for outpatient setting,$29.32 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$24.06 ,100% GA Medicaid fee schedule for outpatient setting,$29.03 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$98.50 ,95% of billed charges for outpatient setting,$24.54 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$88.13 ,85% of billed charges for outpatient setting,$62.21 ,60% of billed charges for outpatient setting,$29.03 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$62.21 ,60% of billed charges for outpatient setting,$24.54 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$24.06 ,$98.50 ,$67.39 
Outpatient Medical Services,LAB,84144,PROGESTERONE,301,$283.00 ,$189.61 ,67% of billed charges for outpatient setting,$79.24 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$25.61 ,100% GA Medicaid fee schedule for outpatient setting,$79.24 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$28.00 ,100% BCBS PPO fee schedule for outpatient setting,$254.70 ,90% of billed charges for outpatient setting,$26.63 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$226.40 ,80% of billed charges for outpatient setting,$212.25 ,75% of billed charges for outpatient setting,$80.03 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$25.61 ,100% GA Medicaid fee schedule for outpatient setting,$79.24 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$268.85 ,95% of billed charges for outpatient setting,$26.12 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$240.55 ,85% of billed charges for outpatient setting,$169.80 ,60% of billed charges for outpatient setting,$79.24 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$169.80 ,60% of billed charges for outpatient setting,$26.12 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$25.61 ,$268.85 ,$183.95 
Outpatient Medical Services,LAB,84146,PROLACTIN,301,$269.00 ,$180.23 ,67% of billed charges for outpatient setting,$75.32 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$24.37 ,100% GA Medicaid fee schedule for outpatient setting,$75.32 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$26.64 ,100% BCBS PPO fee schedule for outpatient setting,$242.10 ,90% of billed charges for outpatient setting,$25.34 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$215.20 ,80% of billed charges for outpatient setting,$201.75 ,75% of billed charges for outpatient setting,$76.07 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$24.37 ,100% GA Medicaid fee schedule for outpatient setting,$75.32 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$255.55 ,95% of billed charges for outpatient setting,$24.86 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$228.65 ,85% of billed charges for outpatient setting,$161.40 ,60% of billed charges for outpatient setting,$75.32 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$161.40 ,60% of billed charges for outpatient setting,$24.86 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$24.37 ,$255.55 ,$174.85 
Outpatient Medical Services,LAB,84156,PROTEIN 24 HR URINE,301,$43.20 ,$28.94 ,67% of billed charges for outpatient setting,$12.10 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$4.61 ,100% GA Medicaid fee schedule for outpatient setting,$12.10 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$5.04 ,100% BCBS PPO fee schedule for outpatient setting,$38.88 ,90% of billed charges for outpatient setting,$4.79 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$34.56 ,80% of billed charges for outpatient setting,$32.40 ,75% of billed charges for outpatient setting,$12.22 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$4.61 ,100% GA Medicaid fee schedule for outpatient setting,$12.10 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$41.04 ,95% of billed charges for outpatient setting,$4.70 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$36.72 ,85% of billed charges for outpatient setting,$25.92 ,60% of billed charges for outpatient setting,$12.10 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$25.92 ,60% of billed charges for outpatient setting,$4.70 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$4.61 ,$41.04 ,$28.08 
Outpatient Medical Services,LAB,84156,PROTEIN URINE,301,$43.20 ,$28.94 ,67% of billed charges for outpatient setting,$12.10 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$4.61 ,100% GA Medicaid fee schedule for outpatient setting,$12.10 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$5.04 ,100% BCBS PPO fee schedule for outpatient setting,$38.88 ,90% of billed charges for outpatient setting,$4.79 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$34.56 ,80% of billed charges for outpatient setting,$32.40 ,75% of billed charges for outpatient setting,$12.22 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$4.61 ,100% GA Medicaid fee schedule for outpatient setting,$12.10 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$41.04 ,95% of billed charges for outpatient setting,$4.70 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$36.72 ,85% of billed charges for outpatient setting,$25.92 ,60% of billed charges for outpatient setting,$12.10 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$25.92 ,60% of billed charges for outpatient setting,$4.70 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$4.61 ,$41.04 ,$28.08 
Outpatient Medical Services,LAB,84153,PSA DIAGNOSTIC,301,$100.32 ,$67.21 ,67% of billed charges for outpatient setting,$28.09 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$23.13 ,100% GA Medicaid fee schedule for outpatient setting,$28.09 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$25.29 ,100% BCBS PPO fee schedule for outpatient setting,$90.29 ,90% of billed charges for outpatient setting,$24.06 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$80.26 ,80% of billed charges for outpatient setting,$75.24 ,75% of billed charges for outpatient setting,$28.37 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$23.13 ,100% GA Medicaid fee schedule for outpatient setting,$28.09 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$95.30 ,95% of billed charges for outpatient setting,$23.59 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$85.27 ,85% of billed charges for outpatient setting,$60.19 ,60% of billed charges for outpatient setting,$28.09 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$60.19 ,60% of billed charges for outpatient setting,$23.59 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$23.13 ,$95.30 ,$65.21 
Outpatient Medical Services,LAB,85610,PT/INR,305,$37.44 ,$25.08 ,67% of billed charges for outpatient setting,$10.48 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$4.94 ,100% GA Medicaid fee schedule for outpatient setting,$10.48 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$5.40 ,100% BCBS PPO fee schedule for outpatient setting,$33.70 ,90% of billed charges for outpatient setting,$5.14 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$29.95 ,80% of billed charges for outpatient setting,$28.08 ,75% of billed charges for outpatient setting,$10.59 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$4.94 ,100% GA Medicaid fee schedule for outpatient setting,$10.48 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$35.57 ,95% of billed charges for outpatient setting,$5.04 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$31.82 ,85% of billed charges for outpatient setting,$22.46 ,60% of billed charges for outpatient setting,$10.48 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$22.46 ,60% of billed charges for outpatient setting,$5.04 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$4.94 ,$35.57 ,$24.34 
Outpatient Medical Services,LAB,83970,PTH INTACT,301,$180.79 ,$121.13 ,67% of billed charges for outpatient setting,$50.62 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$51.90 ,100% GA Medicaid fee schedule for outpatient setting,$50.62 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$56.74 ,100% BCBS PPO fee schedule for outpatient setting,$162.71 ,90% of billed charges for outpatient setting,$53.98 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$144.63 ,80% of billed charges for outpatient setting,$135.59 ,75% of billed charges for outpatient setting,$51.13 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$51.90 ,100% GA Medicaid fee schedule for outpatient setting,$50.62 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$171.75 ,95% of billed charges for outpatient setting,$52.94 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$153.67 ,85% of billed charges for outpatient setting,$108.47 ,60% of billed charges for outpatient setting,$50.62 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$108.47 ,60% of billed charges for outpatient setting,$52.94 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$50.62 ,$171.75 ,$117.51 
Outpatient Medical Services,LAB,85730,PTT,305,$51.36 ,$34.41 ,67% of billed charges for outpatient setting,$14.38 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$7.54 ,100% GA Medicaid fee schedule for outpatient setting,$14.38 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$8.25 ,100% BCBS PPO fee schedule for outpatient setting,$46.22 ,90% of billed charges for outpatient setting,$7.84 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$41.09 ,80% of billed charges for outpatient setting,$38.52 ,75% of billed charges for outpatient setting,$14.52 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$7.54 ,100% GA Medicaid fee schedule for outpatient setting,$14.38 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$48.79 ,95% of billed charges for outpatient setting,$7.69 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$43.66 ,85% of billed charges for outpatient setting,$30.82 ,60% of billed charges for outpatient setting,$14.38 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$30.82 ,60% of billed charges for outpatient setting,$7.69 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$7.54 ,$48.79 ,$33.38 
Outpatient Medical Services,LAB,86480,QUANTIFERON TB GOLD,302,$358.22 ,$240.01 ,67% of billed charges for outpatient setting,$100.30 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$77.93 ,100% GA Medicaid fee schedule for outpatient setting,$100.30 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$85.20 ,100% BCBS PPO fee schedule for outpatient setting,$322.40 ,90% of billed charges for outpatient setting,$81.05 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$286.58 ,80% of billed charges for outpatient setting,$268.67 ,75% of billed charges for outpatient setting,$101.30 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$77.93 ,100% GA Medicaid fee schedule for outpatient setting,$100.30 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$340.31 ,95% of billed charges for outpatient setting,$79.49 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$304.49 ,85% of billed charges for outpatient setting,$214.93 ,60% of billed charges for outpatient setting,$100.30 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$214.93 ,60% of billed charges for outpatient setting,$79.49 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$77.93 ,$340.31 ,$232.84 
Outpatient Medical Services,LAB,87880,RAPID STREP SCREEN,306,$67.20 ,$45.02 ,67% of billed charges for outpatient setting,$18.82 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,$18.82 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.49 ,100% BCBS PPO fee schedule for outpatient setting,$60.48 ,90% of billed charges for outpatient setting,$15.68 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$53.76 ,80% of billed charges for outpatient setting,$50.40 ,75% of billed charges for outpatient setting,$19.00 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,$18.82 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$63.84 ,95% of billed charges for outpatient setting,$15.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$57.12 ,85% of billed charges for outpatient setting,$40.32 ,60% of billed charges for outpatient setting,$18.82 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$40.32 ,60% of billed charges for outpatient setting,$15.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$15.08 ,$63.84 ,$43.68 
Outpatient Medical Services,LAB,80069,RENAL FUNCTION PANEL,301,$71.28 ,$47.76 ,67% of billed charges for outpatient setting,$19.96 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$10.92 ,100% GA Medicaid fee schedule for outpatient setting,$19.96 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$11.94 ,100% BCBS PPO fee schedule for outpatient setting,$64.15 ,90% of billed charges for outpatient setting,$11.36 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$57.02 ,80% of billed charges for outpatient setting,$53.46 ,75% of billed charges for outpatient setting,$20.16 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$10.92 ,100% GA Medicaid fee schedule for outpatient setting,$19.96 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$67.72 ,95% of billed charges for outpatient setting,$11.14 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$60.59 ,85% of billed charges for outpatient setting,$42.77 ,60% of billed charges for outpatient setting,$19.96 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$42.77 ,60% of billed charges for outpatient setting,$11.14 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$10.92 ,$67.72 ,$46.33 
Outpatient Medical Services,LAB,87631,RESPIRATORY VIRAL PANEL - IN HOUSE,301,$393.00 ,$263.31 ,67% of billed charges for outpatient setting,$110.04 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$74.18 ,100% GA Medicaid fee schedule for outpatient setting,$110.04 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$92.72 ,100% BCBS PPO fee schedule for outpatient setting,$353.70 ,90% of billed charges for outpatient setting,$77.15 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$314.40 ,80% of billed charges for outpatient setting,$294.75 ,75% of billed charges for outpatient setting,$111.14 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$74.18 ,100% GA Medicaid fee schedule for outpatient setting,$110.04 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$373.35 ,95% of billed charges for outpatient setting,$75.66 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$334.05 ,85% of billed charges for outpatient setting,$235.80 ,60% of billed charges for outpatient setting,$110.04 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$235.80 ,60% of billed charges for outpatient setting,$75.66 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$74.18 ,$373.35 ,$255.45 
Outpatient Medical Services,LAB,87631,RESPIRATORY VIRAL PANEL - LABCORP,301,$188.64 ,$126.39 ,67% of billed charges for outpatient setting,$52.82 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$74.18 ,100% GA Medicaid fee schedule for outpatient setting,$52.82 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$92.72 ,100% BCBS PPO fee schedule for outpatient setting,$169.78 ,90% of billed charges for outpatient setting,$77.15 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$150.91 ,80% of billed charges for outpatient setting,$141.48 ,75% of billed charges for outpatient setting,$53.35 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$74.18 ,100% GA Medicaid fee schedule for outpatient setting,$52.82 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$179.21 ,95% of billed charges for outpatient setting,$75.66 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$160.34 ,85% of billed charges for outpatient setting,$113.18 ,60% of billed charges for outpatient setting,$52.82 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$113.18 ,60% of billed charges for outpatient setting,$75.66 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$52.82 ,$179.21 ,$122.62 
Outpatient Medical Services,LAB,85045,RETICULOCYTE COUNT AUTOMATED,305,$35.04 ,$23.48 ,67% of billed charges for outpatient setting,$9.81 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$5.03 ,100% GA Medicaid fee schedule for outpatient setting,$9.81 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$5.50 ,100% BCBS PPO fee schedule for outpatient setting,$31.54 ,90% of billed charges for outpatient setting,$5.23 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$28.03 ,80% of billed charges for outpatient setting,$26.28 ,75% of billed charges for outpatient setting,$9.91 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$5.03 ,100% GA Medicaid fee schedule for outpatient setting,$9.81 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$33.29 ,95% of billed charges for outpatient setting,$5.13 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$29.78 ,85% of billed charges for outpatient setting,$21.02 ,60% of billed charges for outpatient setting,$9.81 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$21.02 ,60% of billed charges for outpatient setting,$5.13 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$5.03 ,$33.29 ,$22.78 
Outpatient Medical Services,LAB,86430,RHEUMATOID FACTOR,302,$156.84 ,$105.08 ,67% of billed charges for outpatient setting,$43.92 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$7.14 ,100% GA Medicaid fee schedule for outpatient setting,$43.92 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$7.80 ,100% BCBS PPO fee schedule for outpatient setting,$141.16 ,90% of billed charges for outpatient setting,$7.43 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$125.47 ,80% of billed charges for outpatient setting,$117.63 ,75% of billed charges for outpatient setting,$44.35 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$7.14 ,100% GA Medicaid fee schedule for outpatient setting,$43.92 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$149.00 ,95% of billed charges for outpatient setting,$7.28 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$133.31 ,85% of billed charges for outpatient setting,$94.10 ,60% of billed charges for outpatient setting,$43.92 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$94.10 ,60% of billed charges for outpatient setting,$7.28 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$7.14 ,$149.00 ,$101.95 
Outpatient Medical Services,LAB,86592,RPR,302,$55.77 ,$37.37 ,67% of billed charges for outpatient setting,$15.62 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$4.65 ,100% GA Medicaid fee schedule for outpatient setting,$15.62 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$5.87 ,100% BCBS PPO fee schedule for outpatient setting,$50.19 ,90% of billed charges for outpatient setting,$4.84 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$44.62 ,80% of billed charges for outpatient setting,$41.83 ,75% of billed charges for outpatient setting,$15.77 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$4.65 ,100% GA Medicaid fee schedule for outpatient setting,$15.62 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$52.98 ,95% of billed charges for outpatient setting,$4.74 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$47.40 ,85% of billed charges for outpatient setting,$33.46 ,60% of billed charges for outpatient setting,$15.62 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$33.46 ,60% of billed charges for outpatient setting,$4.74 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$4.65 ,$52.98 ,$36.25 
Outpatient Medical Services,LAB,87420,RSV,306,$63.00 ,$42.21 ,67% of billed charges for outpatient setting,$17.64 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,$17.64 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.49 ,100% BCBS PPO fee schedule for outpatient setting,$56.70 ,90% of billed charges for outpatient setting,$15.68 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$50.40 ,80% of billed charges for outpatient setting,$47.25 ,75% of billed charges for outpatient setting,$17.82 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,$17.64 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$59.85 ,95% of billed charges for outpatient setting,$15.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$53.55 ,85% of billed charges for outpatient setting,$37.80 ,60% of billed charges for outpatient setting,$17.64 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$37.80 ,60% of billed charges for outpatient setting,$15.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$15.08 ,$59.85 ,$40.95 
Outpatient Medical Services,LAB,86762,RUBELLA AB IGG,302,$45.08 ,$30.20 ,67% of billed charges for outpatient setting,$12.62 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$14.63 ,100% GA Medicaid fee schedule for outpatient setting,$12.62 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.00 ,100% BCBS PPO fee schedule for outpatient setting,$40.57 ,90% of billed charges for outpatient setting,$15.22 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$36.06 ,80% of billed charges for outpatient setting,$33.81 ,75% of billed charges for outpatient setting,$12.75 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$14.63 ,100% GA Medicaid fee schedule for outpatient setting,$12.62 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$42.83 ,95% of billed charges for outpatient setting,$14.92 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$38.32 ,85% of billed charges for outpatient setting,$27.05 ,60% of billed charges for outpatient setting,$12.62 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$27.05 ,60% of billed charges for outpatient setting,$14.92 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$12.62 ,$42.83 ,$29.30 
Outpatient Medical Services,LAB,87640,S. AUREUS AMPLIFIED PROBE TECHNIQUE,306,$79.20 ,$53.06 ,67% of billed charges for outpatient setting,$22.18 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$24.67 ,100% GA Medicaid fee schedule for outpatient setting,$22.18 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$26.97 ,100% BCBS PPO fee schedule for outpatient setting,$71.28 ,90% of billed charges for outpatient setting,$25.66 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$63.36 ,80% of billed charges for outpatient setting,$59.40 ,75% of billed charges for outpatient setting,$22.40 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$24.67 ,100% GA Medicaid fee schedule for outpatient setting,$22.18 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$75.24 ,95% of billed charges for outpatient setting,$25.16 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$67.32 ,85% of billed charges for outpatient setting,$47.52 ,60% of billed charges for outpatient setting,$22.18 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$47.52 ,60% of billed charges for outpatient setting,$25.16 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$22.18 ,$75.24 ,$51.48 
Outpatient Medical Services,LAB,80307,SALICYLATES,301,$188.76 ,$126.47 ,67% of billed charges for outpatient setting,$52.85 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$61.16 ,100% GA Medicaid fee schedule for outpatient setting,$52.85 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$137.79 ,73% of billed charges for outpatient setting,$169.88 ,90% of billed charges for outpatient setting,$63.61 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$151.01 ,80% of billed charges for outpatient setting,$141.57 ,75% of billed charges for outpatient setting,$53.38 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$61.16 ,100% GA Medicaid fee schedule for outpatient setting,$52.85 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$179.32 ,95% of billed charges for outpatient setting,$62.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$160.45 ,85% of billed charges for outpatient setting,$113.26 ,60% of billed charges for outpatient setting,$52.85 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$113.26 ,60% of billed charges for outpatient setting,$62.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$52.85 ,$179.32 ,$122.69 
Outpatient Medical Services,LAB,85652,SED RATE AUTOMATED,305,$19.68 ,$13.19 ,67% of billed charges for outpatient setting,$5.51 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$3.39 ,100% GA Medicaid fee schedule for outpatient setting,$5.51 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$3.71 ,100% BCBS PPO fee schedule for outpatient setting,$17.71 ,90% of billed charges for outpatient setting,$3.53 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$15.74 ,80% of billed charges for outpatient setting,$14.76 ,75% of billed charges for outpatient setting,$5.57 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$3.39 ,100% GA Medicaid fee schedule for outpatient setting,$5.51 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$18.70 ,95% of billed charges for outpatient setting,$3.46 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$16.73 ,85% of billed charges for outpatient setting,$11.81 ,60% of billed charges for outpatient setting,$5.51 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$11.81 ,60% of billed charges for outpatient setting,$3.46 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$3.39 ,$18.70 ,$12.79 
Outpatient Medical Services,LAB,84165,SERUM PROTEIN ELECTROPHORESIS,301,$113.26 ,$75.88 ,67% of billed charges for outpatient setting,$31.71 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$13.51 ,100% GA Medicaid fee schedule for outpatient setting,$31.71 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$14.76 ,100% BCBS PPO fee schedule for outpatient setting,$101.93 ,90% of billed charges for outpatient setting,$14.05 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$90.61 ,80% of billed charges for outpatient setting,$84.95 ,75% of billed charges for outpatient setting,$32.03 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$13.51 ,100% GA Medicaid fee schedule for outpatient setting,$31.71 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$107.60 ,95% of billed charges for outpatient setting,$13.78 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$96.27 ,85% of billed charges for outpatient setting,$67.96 ,60% of billed charges for outpatient setting,$31.71 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$67.96 ,60% of billed charges for outpatient setting,$13.78 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$13.51 ,$107.60 ,$73.62 
Outpatient Medical Services,LAB,87899,SHIGA TOXIN 1,306,$213.00 ,$142.71 ,67% of billed charges for outpatient setting,$59.64 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,$59.64 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.49 ,100% BCBS PPO fee schedule for outpatient setting,$191.70 ,90% of billed charges for outpatient setting,$15.68 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$170.40 ,80% of billed charges for outpatient setting,$159.75 ,75% of billed charges for outpatient setting,$60.24 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,$59.64 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$202.35 ,95% of billed charges for outpatient setting,$15.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$181.05 ,85% of billed charges for outpatient setting,$127.80 ,60% of billed charges for outpatient setting,$59.64 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$127.80 ,60% of billed charges for outpatient setting,$15.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$15.08 ,$202.35 ,$138.45 
Outpatient Medical Services,LAB,87899,SHIGA TOXIN 2,306,$213.00 ,$142.71 ,67% of billed charges for outpatient setting,$59.64 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,$59.64 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.49 ,100% BCBS PPO fee schedule for outpatient setting,$191.70 ,90% of billed charges for outpatient setting,$15.68 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$170.40 ,80% of billed charges for outpatient setting,$159.75 ,75% of billed charges for outpatient setting,$60.24 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$15.08 ,100% GA Medicaid fee schedule for outpatient setting,$59.64 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$202.35 ,95% of billed charges for outpatient setting,$15.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$181.05 ,85% of billed charges for outpatient setting,$127.80 ,60% of billed charges for outpatient setting,$59.64 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$127.80 ,60% of billed charges for outpatient setting,$15.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$15.08 ,$202.35 ,$138.45 
Outpatient Medical Services,LAB,84295,SODIUM,301,$21.60 ,$14.47 ,67% of billed charges for outpatient setting,$6.05 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$6.05 ,100% GA Medicaid fee schedule for outpatient setting,$6.05 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$6.62 ,100% BCBS PPO fee schedule for outpatient setting,$19.44 ,90% of billed charges for outpatient setting,$6.29 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$17.28 ,80% of billed charges for outpatient setting,$16.20 ,75% of billed charges for outpatient setting,$6.11 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$6.05 ,100% GA Medicaid fee schedule for outpatient setting,$6.05 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$20.52 ,95% of billed charges for outpatient setting,$6.17 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$18.36 ,85% of billed charges for outpatient setting,$12.96 ,60% of billed charges for outpatient setting,$6.05 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$12.96 ,60% of billed charges for outpatient setting,$6.17 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$6.05 ,$20.52 ,$14.04 
Outpatient Medical Services,LAB,84300,SODIUM URINE,301,$31.68 ,$21.23 ,67% of billed charges for outpatient setting,$8.87 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$4.35 ,100% GA Medicaid fee schedule for outpatient setting,$8.87 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$4.75 ,100% BCBS PPO fee schedule for outpatient setting,$28.51 ,90% of billed charges for outpatient setting,$4.52 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$25.34 ,80% of billed charges for outpatient setting,$23.76 ,75% of billed charges for outpatient setting,$8.96 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$4.35 ,100% GA Medicaid fee schedule for outpatient setting,$8.87 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$30.10 ,95% of billed charges for outpatient setting,$4.44 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$26.93 ,85% of billed charges for outpatient setting,$19.01 ,60% of billed charges for outpatient setting,$8.87 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$19.01 ,60% of billed charges for outpatient setting,$4.44 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$4.35 ,$30.10 ,$20.59 
Outpatient Medical Services,LAB,88312,SPEC STAINS- MICROORGANISMS,312,$160.80 ,$107.74 ,67% of billed charges for outpatient setting,$45.02 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$43.39 ,100% GA Medicaid fee schedule for outpatient setting,$45.02 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$117.38 ,73% of billed charges for outpatient setting,$144.72 ,90% of billed charges for outpatient setting,$45.13 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$128.64 ,80% of billed charges for outpatient setting,$120.60 ,75% of billed charges for outpatient setting,$45.47 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$43.39 ,100% GA Medicaid fee schedule for outpatient setting,$45.02 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$152.76 ,95% of billed charges for outpatient setting,$44.26 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$136.68 ,85% of billed charges for outpatient setting,$96.48 ,60% of billed charges for outpatient setting,$45.02 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$96.48 ,60% of billed charges for outpatient setting,$44.26 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$43.39 ,$152.76 ,$104.52 
Outpatient Medical Services,LAB,87081,STREP CONFIRMATION,300,$48.16 ,$32.27 ,67% of billed charges for outpatient setting,$13.48 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$8.33 ,100% GA Medicaid fee schedule for outpatient setting,$13.48 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$9.12 ,100% BCBS PPO fee schedule for outpatient setting,$43.34 ,90% of billed charges for outpatient setting,$8.66 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$38.53 ,80% of billed charges for outpatient setting,$36.12 ,75% of billed charges for outpatient setting,$13.62 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$8.33 ,100% GA Medicaid fee schedule for outpatient setting,$13.48 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$45.75 ,95% of billed charges for outpatient setting,$8.50 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$40.94 ,85% of billed charges for outpatient setting,$28.90 ,60% of billed charges for outpatient setting,$13.48 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$28.90 ,60% of billed charges for outpatient setting,$8.50 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$8.33 ,$45.75 ,$31.30 
Outpatient Medical Services,LAB,88304,SURGICAL PATH LEVEL 3,312,$457.68 ,$306.65 ,67% of billed charges for outpatient setting,$128.15 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$30.18 ,100% GA Medicaid fee schedule for outpatient setting,$128.15 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$334.11 ,73% of billed charges for outpatient setting,$411.91 ,90% of billed charges for outpatient setting,$31.39 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$366.14 ,80% of billed charges for outpatient setting,$343.26 ,75% of billed charges for outpatient setting,$129.43 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$30.18 ,100% GA Medicaid fee schedule for outpatient setting,$128.15 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$434.80 ,95% of billed charges for outpatient setting,$30.78 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$389.03 ,85% of billed charges for outpatient setting,$274.61 ,60% of billed charges for outpatient setting,$128.15 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$274.61 ,60% of billed charges for outpatient setting,$30.78 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$30.18 ,$434.80 ,$297.49 
Outpatient Medical Services,LAB,88305,SURGICAL PATH LEVEL 4,310,$206.88 ,$138.61 ,67% of billed charges for outpatient setting,$57.93 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$65.88 ,100% GA Medicaid fee schedule for outpatient setting,$57.93 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$151.02 ,73% of billed charges for outpatient setting,$186.19 ,90% of billed charges for outpatient setting,$68.52 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$165.50 ,80% of billed charges for outpatient setting,$155.16 ,75% of billed charges for outpatient setting,$58.51 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$65.88 ,100% GA Medicaid fee schedule for outpatient setting,$57.93 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$196.54 ,95% of billed charges for outpatient setting,$67.20 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$175.85 ,85% of billed charges for outpatient setting,$124.13 ,60% of billed charges for outpatient setting,$57.93 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$124.13 ,60% of billed charges for outpatient setting,$67.20 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$57.93 ,$196.54 ,$134.47 
Outpatient Medical Services,LAB,88307,SURGICAL PATH LEVEL 5,312,$783.97 ,$525.26 ,67% of billed charges for outpatient setting,$219.51 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$133.30 ,100% GA Medicaid fee schedule for outpatient setting,$219.51 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$572.30 ,73% of billed charges for outpatient setting,$705.57 ,90% of billed charges for outpatient setting,$138.63 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$627.18 ,80% of billed charges for outpatient setting,$587.98 ,75% of billed charges for outpatient setting,$221.71 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$133.30 ,100% GA Medicaid fee schedule for outpatient setting,$219.51 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$744.77 ,95% of billed charges for outpatient setting,$135.97 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$666.37 ,85% of billed charges for outpatient setting,$470.38 ,60% of billed charges for outpatient setting,$219.51 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$470.38 ,60% of billed charges for outpatient setting,$135.97 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$133.30 ,$744.77 ,$509.58 
Outpatient Medical Services,LAB,84481,T3 FREE,300,$198.84 ,$133.22 ,67% of billed charges for outpatient setting,$55.68 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$21.30 ,100% GA Medicaid fee schedule for outpatient setting,$55.68 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$23.29 ,100% BCBS PPO fee schedule for outpatient setting,$178.96 ,90% of billed charges for outpatient setting,$22.15 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$159.07 ,80% of billed charges for outpatient setting,$149.13 ,75% of billed charges for outpatient setting,$56.23 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$21.30 ,100% GA Medicaid fee schedule for outpatient setting,$55.68 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$188.90 ,95% of billed charges for outpatient setting,$21.73 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$169.01 ,85% of billed charges for outpatient setting,$119.30 ,60% of billed charges for outpatient setting,$55.68 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$119.30 ,60% of billed charges for outpatient setting,$21.73 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$21.30 ,$188.90 ,$129.25 
Outpatient Medical Services,LAB,84480,T3 TOTAL,301,$185.52 ,$124.30 ,67% of billed charges for outpatient setting,$51.95 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.03 ,100% GA Medicaid fee schedule for outpatient setting,$51.95 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$17.53 ,100% BCBS PPO fee schedule for outpatient setting,$166.97 ,90% of billed charges for outpatient setting,$16.67 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$148.42 ,80% of billed charges for outpatient setting,$139.14 ,75% of billed charges for outpatient setting,$52.47 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$16.03 ,100% GA Medicaid fee schedule for outpatient setting,$51.95 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$176.24 ,95% of billed charges for outpatient setting,$16.35 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$157.69 ,85% of billed charges for outpatient setting,$111.31 ,60% of billed charges for outpatient setting,$51.95 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$111.31 ,60% of billed charges for outpatient setting,$16.35 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$16.03 ,$176.24 ,$120.59 
Outpatient Medical Services,LAB,84479,T3 UPTAKE,301,$94.04 ,$63.01 ,67% of billed charges for outpatient setting,$26.33 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$8.14 ,100% GA Medicaid fee schedule for outpatient setting,$26.33 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$8.89 ,100% BCBS PPO fee schedule for outpatient setting,$84.64 ,90% of billed charges for outpatient setting,$8.47 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$75.23 ,80% of billed charges for outpatient setting,$70.53 ,75% of billed charges for outpatient setting,$26.59 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$8.14 ,100% GA Medicaid fee schedule for outpatient setting,$26.33 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$89.34 ,95% of billed charges for outpatient setting,$8.30 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$79.93 ,85% of billed charges for outpatient setting,$56.42 ,60% of billed charges for outpatient setting,$26.33 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$56.42 ,60% of billed charges for outpatient setting,$8.30 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$8.14 ,$89.34 ,$61.13 
Outpatient Medical Services,LAB,84436,T4,301,$106.85 ,$71.59 ,67% of billed charges for outpatient setting,$29.92 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$8.65 ,100% GA Medicaid fee schedule for outpatient setting,$29.92 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$9.44 ,100% BCBS PPO fee schedule for outpatient setting,$96.17 ,90% of billed charges for outpatient setting,$9.00 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$85.48 ,80% of billed charges for outpatient setting,$80.14 ,75% of billed charges for outpatient setting,$30.22 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$8.65 ,100% GA Medicaid fee schedule for outpatient setting,$29.92 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$101.51 ,95% of billed charges for outpatient setting,$8.82 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$90.82 ,85% of billed charges for outpatient setting,$64.11 ,60% of billed charges for outpatient setting,$29.92 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$64.11 ,60% of billed charges for outpatient setting,$8.82 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$8.65 ,$101.51 ,$69.45 
Outpatient Medical Services,LAB,84439,T4 FREE,301,$165.33 ,$110.77 ,67% of billed charges for outpatient setting,$46.29 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$11.34 ,100% GA Medicaid fee schedule for outpatient setting,$46.29 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$12.40 ,100% BCBS PPO fee schedule for outpatient setting,$148.80 ,90% of billed charges for outpatient setting,$11.79 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$132.26 ,80% of billed charges for outpatient setting,$124.00 ,75% of billed charges for outpatient setting,$46.76 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$11.34 ,100% GA Medicaid fee schedule for outpatient setting,$46.29 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$157.06 ,95% of billed charges for outpatient setting,$11.57 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$140.53 ,85% of billed charges for outpatient setting,$99.20 ,60% of billed charges for outpatient setting,$46.29 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$99.20 ,60% of billed charges for outpatient setting,$11.57 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$11.34 ,$157.06 ,$107.46 
Outpatient Medical Services,LAB,80197,TACROLIMUS,300,$327.36 ,$219.33 ,67% of billed charges for outpatient setting,$91.66 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$17.25 ,100% GA Medicaid fee schedule for outpatient setting,$91.66 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$18.87 ,100% BCBS PPO fee schedule for outpatient setting,$294.62 ,90% of billed charges for outpatient setting,$17.94 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$261.89 ,80% of billed charges for outpatient setting,$245.52 ,75% of billed charges for outpatient setting,$92.58 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$17.25 ,100% GA Medicaid fee schedule for outpatient setting,$91.66 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$310.99 ,95% of billed charges for outpatient setting,$17.60 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$278.26 ,85% of billed charges for outpatient setting,$196.42 ,60% of billed charges for outpatient setting,$91.66 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$196.42 ,60% of billed charges for outpatient setting,$17.60 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$17.25 ,$310.99 ,$212.78 
Outpatient Medical Services,LAB,84402,TESTOSTERONE FREE,301,$291.00 ,$194.97 ,67% of billed charges for outpatient setting,$81.48 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$32.01 ,100% GA Medicaid fee schedule for outpatient setting,$81.48 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$35.00 ,100% BCBS PPO fee schedule for outpatient setting,$261.90 ,90% of billed charges for outpatient setting,$33.29 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$232.80 ,80% of billed charges for outpatient setting,$218.25 ,75% of billed charges for outpatient setting,$82.29 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$32.01 ,100% GA Medicaid fee schedule for outpatient setting,$81.48 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$276.45 ,95% of billed charges for outpatient setting,$32.65 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$247.35 ,85% of billed charges for outpatient setting,$174.60 ,60% of billed charges for outpatient setting,$81.48 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$174.60 ,60% of billed charges for outpatient setting,$32.65 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$32.01 ,$276.45 ,$189.15 
Outpatient Medical Services,LAB,84403,TESTOSTERONE TOTAL,301,$283.45 ,$189.91 ,67% of billed charges for outpatient setting,$79.37 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$32.47 ,100% GA Medicaid fee schedule for outpatient setting,$79.37 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$35.49 ,100% BCBS PPO fee schedule for outpatient setting,$255.11 ,90% of billed charges for outpatient setting,$33.77 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$226.76 ,80% of billed charges for outpatient setting,$212.59 ,75% of billed charges for outpatient setting,$80.16 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$32.47 ,100% GA Medicaid fee schedule for outpatient setting,$79.37 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$269.28 ,95% of billed charges for outpatient setting,$33.12 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$240.93 ,85% of billed charges for outpatient setting,$170.07 ,60% of billed charges for outpatient setting,$79.37 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$170.07 ,60% of billed charges for outpatient setting,$33.12 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$32.47 ,$269.28 ,$184.24 
Outpatient Medical Services,LAB,86376,THYROID PEROXIDASE AB,300,$255.00 ,$170.85 ,67% of billed charges for outpatient setting,$71.40 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$18.30 ,100% GA Medicaid fee schedule for outpatient setting,$71.40 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$19.99 ,100% BCBS PPO fee schedule for outpatient setting,$229.50 ,90% of billed charges for outpatient setting,$19.03 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$204.00 ,80% of billed charges for outpatient setting,$191.25 ,75% of billed charges for outpatient setting,$72.11 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$18.30 ,100% GA Medicaid fee schedule for outpatient setting,$71.40 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$242.25 ,95% of billed charges for outpatient setting,$18.67 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$216.75 ,85% of billed charges for outpatient setting,$153.00 ,60% of billed charges for outpatient setting,$71.40 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$153.00 ,60% of billed charges for outpatient setting,$18.67 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$18.30 ,$242.25 ,$165.75 
Outpatient Medical Services,LAB,83550,TIBC,301,$43.40 ,$29.08 ,67% of billed charges for outpatient setting,$12.15 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$10.99 ,100% GA Medicaid fee schedule for outpatient setting,$12.15 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$12.02 ,100% BCBS PPO fee schedule for outpatient setting,$39.06 ,90% of billed charges for outpatient setting,$11.43 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$34.72 ,80% of billed charges for outpatient setting,$32.55 ,75% of billed charges for outpatient setting,$12.27 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$10.99 ,100% GA Medicaid fee schedule for outpatient setting,$12.15 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$41.23 ,95% of billed charges for outpatient setting,$11.21 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$36.89 ,85% of billed charges for outpatient setting,$26.04 ,60% of billed charges for outpatient setting,$12.15 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$26.04 ,60% of billed charges for outpatient setting,$11.21 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$10.99 ,$41.23 ,$28.21 
Outpatient Medical Services,LAB,83516,TRANSGLUTAMINASE AB (IGA),301,$291.00 ,$194.97 ,67% of billed charges for outpatient setting,$81.48 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$13.45 ,100% GA Medicaid fee schedule for outpatient setting,$81.48 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$14.69 ,100% BCBS PPO fee schedule for outpatient setting,$261.90 ,90% of billed charges for outpatient setting,$13.99 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$232.80 ,80% of billed charges for outpatient setting,$218.25 ,75% of billed charges for outpatient setting,$82.29 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$13.45 ,100% GA Medicaid fee schedule for outpatient setting,$81.48 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$276.45 ,95% of billed charges for outpatient setting,$13.72 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$247.35 ,85% of billed charges for outpatient setting,$174.60 ,60% of billed charges for outpatient setting,$81.48 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$174.60 ,60% of billed charges for outpatient setting,$13.72 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$13.45 ,$276.45 ,$189.15 
Outpatient Medical Services,LAB,83516,TRANSGLUTAMINASE AB (IGG),301,$291.00 ,$194.97 ,67% of billed charges for outpatient setting,$81.48 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$13.45 ,100% GA Medicaid fee schedule for outpatient setting,$81.48 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$14.69 ,100% BCBS PPO fee schedule for outpatient setting,$261.90 ,90% of billed charges for outpatient setting,$13.99 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$232.80 ,80% of billed charges for outpatient setting,$218.25 ,75% of billed charges for outpatient setting,$82.29 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$13.45 ,100% GA Medicaid fee schedule for outpatient setting,$81.48 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$276.45 ,95% of billed charges for outpatient setting,$13.72 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$247.35 ,85% of billed charges for outpatient setting,$174.60 ,60% of billed charges for outpatient setting,$81.48 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$174.60 ,60% of billed charges for outpatient setting,$13.72 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$13.45 ,$276.45 ,$189.15 
Outpatient Medical Services,LAB,87661,TRICHOMONAS VAGINALIS PCR,306,$150.00 ,$100.50 ,67% of billed charges for outpatient setting,$42.00 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$21.42 ,100% GA Medicaid fee schedule for outpatient setting,$42.00 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$109.50 ,73% of billed charges for outpatient setting,$135.00 ,90% of billed charges for outpatient setting,$22.28 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$120.00 ,80% of billed charges for outpatient setting,$112.50 ,75% of billed charges for outpatient setting,$42.42 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$21.42 ,100% GA Medicaid fee schedule for outpatient setting,$42.00 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$142.50 ,95% of billed charges for outpatient setting,$21.85 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$127.50 ,85% of billed charges for outpatient setting,$90.00 ,60% of billed charges for outpatient setting,$42.00 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$90.00 ,60% of billed charges for outpatient setting,$21.85 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$21.42 ,$142.50 ,$97.50 
Outpatient Medical Services,LAB,84478,TRIGLYCERIDES,301,$89.58 ,$60.02 ,67% of billed charges for outpatient setting,$25.08 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$6.35 ,100% GA Medicaid fee schedule for outpatient setting,$25.08 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$7.90 ,100% BCBS PPO fee schedule for outpatient setting,$80.62 ,90% of billed charges for outpatient setting,$6.60 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$71.66 ,80% of billed charges for outpatient setting,$67.19 ,75% of billed charges for outpatient setting,$25.33 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$6.35 ,100% GA Medicaid fee schedule for outpatient setting,$25.08 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$85.10 ,95% of billed charges for outpatient setting,$6.48 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$76.14 ,85% of billed charges for outpatient setting,$53.75 ,60% of billed charges for outpatient setting,$25.08 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$53.75 ,60% of billed charges for outpatient setting,$6.48 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$6.35 ,$85.10 ,$58.23 
Outpatient Medical Services,LAB,84484,TROPONIN I,301,$48.00 ,$32.16 ,67% of billed charges for outpatient setting,$13.44 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$12.38 ,100% GA Medicaid fee schedule for outpatient setting,$13.44 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$13.53 ,100% BCBS PPO fee schedule for outpatient setting,$43.20 ,90% of billed charges for outpatient setting,$12.88 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$38.40 ,80% of billed charges for outpatient setting,$36.00 ,75% of billed charges for outpatient setting,$13.57 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$12.38 ,100% GA Medicaid fee schedule for outpatient setting,$13.44 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$45.60 ,95% of billed charges for outpatient setting,$12.63 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$40.80 ,85% of billed charges for outpatient setting,$28.80 ,60% of billed charges for outpatient setting,$13.44 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$28.80 ,60% of billed charges for outpatient setting,$12.63 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$12.38 ,$45.60 ,$31.20 
Outpatient Medical Services,LAB,84443,TSH,301,$191.11 ,$128.04 ,67% of billed charges for outpatient setting,$53.51 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$21.12 ,100% GA Medicaid fee schedule for outpatient setting,$53.51 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$23.10 ,100% BCBS PPO fee schedule for outpatient setting,$172.00 ,90% of billed charges for outpatient setting,$21.96 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$152.89 ,80% of billed charges for outpatient setting,$143.33 ,75% of billed charges for outpatient setting,$54.05 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$21.12 ,100% GA Medicaid fee schedule for outpatient setting,$53.51 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$181.55 ,95% of billed charges for outpatient setting,$21.54 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$162.44 ,85% of billed charges for outpatient setting,$114.67 ,60% of billed charges for outpatient setting,$53.51 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$114.67 ,60% of billed charges for outpatient setting,$21.54 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$21.12 ,$181.55 ,$124.22 
Outpatient Medical Services,LAB,84550,URIC ACID,301,$36.13 ,$24.21 ,67% of billed charges for outpatient setting,$10.12 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$5.68 ,100% GA Medicaid fee schedule for outpatient setting,$10.12 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$6.21 ,100% BCBS PPO fee schedule for outpatient setting,$32.52 ,90% of billed charges for outpatient setting,$5.91 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$28.90 ,80% of billed charges for outpatient setting,$27.10 ,75% of billed charges for outpatient setting,$10.22 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$5.68 ,100% GA Medicaid fee schedule for outpatient setting,$10.12 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$34.32 ,95% of billed charges for outpatient setting,$5.79 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$30.71 ,85% of billed charges for outpatient setting,$21.68 ,60% of billed charges for outpatient setting,$10.12 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$21.68 ,60% of billed charges for outpatient setting,$5.79 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$5.68 ,$34.32 ,$23.48 
Outpatient Medical Services,LAB,81001,URINALYSIS COMPLETE,307,$31.00 ,$20.77 ,67% of billed charges for outpatient setting,$8.68 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$3.99 ,100% GA Medicaid fee schedule for outpatient setting,$8.68 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$4.35 ,100% BCBS PPO fee schedule for outpatient setting,$27.90 ,90% of billed charges for outpatient setting,$4.15 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$24.80 ,80% of billed charges for outpatient setting,$23.25 ,75% of billed charges for outpatient setting,$8.77 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$3.99 ,100% GA Medicaid fee schedule for outpatient setting,$8.68 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$29.45 ,95% of billed charges for outpatient setting,$4.07 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$26.35 ,85% of billed charges for outpatient setting,$18.60 ,60% of billed charges for outpatient setting,$8.68 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$18.60 ,60% of billed charges for outpatient setting,$4.07 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$3.99 ,$29.45 ,$20.15 
Outpatient Medical Services,LAB,81003,URINE DIPSTICK ONLY,307,$14.40 ,$9.65 ,67% of billed charges for outpatient setting,$4.03 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$2.83 ,100% GA Medicaid fee schedule for outpatient setting,$4.03 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$3.09 ,100% BCBS PPO fee schedule for outpatient setting,$12.96 ,90% of billed charges for outpatient setting,$2.94 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$11.52 ,80% of billed charges for outpatient setting,$10.80 ,75% of billed charges for outpatient setting,$4.07 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$2.83 ,100% GA Medicaid fee schedule for outpatient setting,$4.03 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$13.68 ,95% of billed charges for outpatient setting,$2.89 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$12.24 ,85% of billed charges for outpatient setting,$8.64 ,60% of billed charges for outpatient setting,$4.03 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$8.64 ,60% of billed charges for outpatient setting,$2.89 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$2.83 ,$13.68 ,$9.36 
Outpatient Medical Services,LAB,84166,URINE PROTEIN ELECTROPHORESIS,301,$142.56 ,$95.52 ,67% of billed charges for outpatient setting,$39.92 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$22.43 ,100% GA Medicaid fee schedule for outpatient setting,$39.92 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$24.52 ,100% BCBS PPO fee schedule for outpatient setting,$128.30 ,90% of billed charges for outpatient setting,$23.33 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$114.05 ,80% of billed charges for outpatient setting,$106.92 ,75% of billed charges for outpatient setting,$40.32 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$22.43 ,100% GA Medicaid fee schedule for outpatient setting,$39.92 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$135.43 ,95% of billed charges for outpatient setting,$22.88 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$121.18 ,85% of billed charges for outpatient setting,$85.54 ,60% of billed charges for outpatient setting,$39.92 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$85.54 ,60% of billed charges for outpatient setting,$22.88 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$22.43 ,$135.43 ,$92.66 
Outpatient Medical Services,LAB,80164,VALPROIC ACID TOTAL,301,$56.16 ,$37.63 ,67% of billed charges for outpatient setting,$15.72 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$14.27 ,100% GA Medicaid fee schedule for outpatient setting,$15.72 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$15.61 ,100% BCBS PPO fee schedule for outpatient setting,$50.54 ,90% of billed charges for outpatient setting,$14.84 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$44.93 ,80% of billed charges for outpatient setting,$42.12 ,75% of billed charges for outpatient setting,$15.88 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$14.27 ,100% GA Medicaid fee schedule for outpatient setting,$15.72 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$53.35 ,95% of billed charges for outpatient setting,$14.56 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$47.74 ,85% of billed charges for outpatient setting,$33.70 ,60% of billed charges for outpatient setting,$15.72 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$33.70 ,60% of billed charges for outpatient setting,$14.56 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$14.27 ,$53.35 ,$36.50 
Outpatient Medical Services,LAB,80202,VANCOMYCIN TROUGH,301,$43.56 ,$29.19 ,67% of billed charges for outpatient setting,$12.20 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$14.27 ,100% GA Medicaid fee schedule for outpatient setting,$12.20 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$15.61 ,100% BCBS PPO fee schedule for outpatient setting,$39.20 ,90% of billed charges for outpatient setting,$14.84 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$34.85 ,80% of billed charges for outpatient setting,$32.67 ,75% of billed charges for outpatient setting,$12.32 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$14.27 ,100% GA Medicaid fee schedule for outpatient setting,$12.20 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$41.38 ,95% of billed charges for outpatient setting,$14.56 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$37.03 ,85% of billed charges for outpatient setting,$26.14 ,60% of billed charges for outpatient setting,$12.20 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$26.14 ,60% of billed charges for outpatient setting,$14.56 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$12.20 ,$41.38 ,$28.31 
Outpatient Medical Services,LAB,86787,VARICELLA ZOSTER VIRUS AB IGG,302,$191.17 ,$128.08 ,67% of billed charges for outpatient setting,$53.53 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$16.20 ,100% GA Medicaid fee schedule for outpatient setting,$53.53 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$17.71 ,100% BCBS PPO fee schedule for outpatient setting,$172.05 ,90% of billed charges for outpatient setting,$16.85 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$152.94 ,80% of billed charges for outpatient setting,$143.38 ,75% of billed charges for outpatient setting,$54.06 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$16.20 ,100% GA Medicaid fee schedule for outpatient setting,$53.53 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$181.61 ,95% of billed charges for outpatient setting,$16.52 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$162.49 ,85% of billed charges for outpatient setting,$114.70 ,60% of billed charges for outpatient setting,$53.53 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$114.70 ,60% of billed charges for outpatient setting,$16.52 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$16.20 ,$181.61 ,$124.26 
Outpatient Medical Services,LAB,84425,VITAMIN B 1 WHOLE BLOOD,301,$222.83 ,$149.30 ,67% of billed charges for outpatient setting,$62.39 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$26.70 ,100% GA Medicaid fee schedule for outpatient setting,$62.39 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$29.19 ,100% BCBS PPO fee schedule for outpatient setting,$200.55 ,90% of billed charges for outpatient setting,$27.77 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$178.26 ,80% of billed charges for outpatient setting,$167.12 ,75% of billed charges for outpatient setting,$63.02 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$26.70 ,100% GA Medicaid fee schedule for outpatient setting,$62.39 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$211.69 ,95% of billed charges for outpatient setting,$27.23 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$189.41 ,85% of billed charges for outpatient setting,$133.70 ,60% of billed charges for outpatient setting,$62.39 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$133.70 ,60% of billed charges for outpatient setting,$27.23 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$26.70 ,$211.69 ,$144.84 
Outpatient Medical Services,LAB,82607,VITAMIN B12,301,$70.56 ,$47.28 ,67% of billed charges for outpatient setting,$19.76 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$18.95 ,100% GA Medicaid fee schedule for outpatient setting,$19.76 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$20.72 ,100% BCBS PPO fee schedule for outpatient setting,$63.50 ,90% of billed charges for outpatient setting,$19.71 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$56.45 ,80% of billed charges for outpatient setting,$52.92 ,75% of billed charges for outpatient setting,$19.95 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$18.95 ,100% GA Medicaid fee schedule for outpatient setting,$19.76 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$67.03 ,95% of billed charges for outpatient setting,$19.33 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$59.98 ,85% of billed charges for outpatient setting,$42.34 ,60% of billed charges for outpatient setting,$19.76 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$42.34 ,60% of billed charges for outpatient setting,$19.33 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$18.95 ,$67.03 ,$45.86 
Outpatient Medical Services,LAB,82652,"VITAMIN D, 1,25-DIHYDROXY",301,$395.24 ,$264.81 ,67% of billed charges for outpatient setting,$110.67 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$48.40 ,100% GA Medicaid fee schedule for outpatient setting,$110.67 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$52.92 ,100% BCBS PPO fee schedule for outpatient setting,$355.72 ,90% of billed charges for outpatient setting,$50.34 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$316.19 ,80% of billed charges for outpatient setting,$296.43 ,75% of billed charges for outpatient setting,$111.77 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$48.40 ,100% GA Medicaid fee schedule for outpatient setting,$110.67 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$375.48 ,95% of billed charges for outpatient setting,$49.37 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$335.95 ,85% of billed charges for outpatient setting,$237.14 ,60% of billed charges for outpatient setting,$110.67 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$237.14 ,60% of billed charges for outpatient setting,$49.37 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$48.40 ,$375.48 ,$256.91 
Outpatient Medical Services,LAB,82306,"VITAMIN D, 25-HYDROXY",300,$277.00 ,$185.59 ,67% of billed charges for outpatient setting,$77.56 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$37.22 ,100% GA Medicaid fee schedule for outpatient setting,$77.56 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$40.70 ,100% BCBS PPO fee schedule for outpatient setting,$249.30 ,90% of billed charges for outpatient setting,$38.71 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$221.60 ,80% of billed charges for outpatient setting,$207.75 ,75% of billed charges for outpatient setting,$78.34 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$37.22 ,100% GA Medicaid fee schedule for outpatient setting,$77.56 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$263.15 ,95% of billed charges for outpatient setting,$37.96 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$235.45 ,85% of billed charges for outpatient setting,$166.20 ,60% of billed charges for outpatient setting,$77.56 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$166.20 ,60% of billed charges for outpatient setting,$37.96 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$37.22 ,$263.15 ,$180.05 
Outpatient Medical Services,LAB,87210,"WET PREP, VAGINAL",306,$84.48 ,$56.60 ,67% of billed charges for outpatient setting,$23.65 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$5.36 ,100% GA Medicaid fee schedule for outpatient setting,$23.65 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$5.87 ,100% BCBS PPO fee schedule for outpatient setting,$76.03 ,90% of billed charges for outpatient setting,$5.57 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$67.58 ,80% of billed charges for outpatient setting,$63.36 ,75% of billed charges for outpatient setting,$23.89 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$5.36 ,100% GA Medicaid fee schedule for outpatient setting,$23.65 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$80.26 ,95% of billed charges for outpatient setting,$5.47 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$71.81 ,85% of billed charges for outpatient setting,$50.69 ,60% of billed charges for outpatient setting,$23.65 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$50.69 ,60% of billed charges for outpatient setting,$5.47 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$5.36 ,$80.26 ,$54.91 
Outpatient Medical Services,VISIT,99212,"Office Visit, Est Pt., Level 2",,$110.00 ,$73.70 ,67% of billed charges for outpatient setting,$30.80 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$29.45 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$30.80 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$80.30 ,73% of billed charges for outpatient setting,$99.00 ,90% of billed charges for outpatient setting,$30.63 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$88.00 ,80% of billed charges for outpatient setting,$82.50 ,75% of billed charges for outpatient setting,$31.11 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$29.45 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$30.80 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$104.50 ,95% of billed charges for outpatient setting,$30.04 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$93.50 ,85% of billed charges for outpatient setting,$66.00 ,60% of billed charges for outpatient setting,$30.80 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$66.00 ,60% of billed charges for outpatient setting,$30.04 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$29.45 ,$104.50 ,$71.50 
Outpatient Medical Services,VISIT,99213,"Office Visit, Est Pt., Level 3",,$141.00 ,$94.47 ,67% of billed charges for outpatient setting,$39.48 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$37.75 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$39.48 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$102.93 ,73% of billed charges for outpatient setting,$126.90 ,90% of billed charges for outpatient setting,$39.26 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$112.80 ,80% of billed charges for outpatient setting,$105.75 ,75% of billed charges for outpatient setting,$39.87 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$37.75 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$39.48 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$133.95 ,95% of billed charges for outpatient setting,$38.51 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$119.85 ,85% of billed charges for outpatient setting,$84.60 ,60% of billed charges for outpatient setting,$39.48 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$84.60 ,60% of billed charges for outpatient setting,$38.51 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$37.75 ,$133.95 ,$91.65 
Outpatient Medical Services,VISIT,99214,"Office Visit, Est Pt., Level 4",,$204.00 ,$136.68 ,67% of billed charges for outpatient setting,$57.12 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$54.61 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$57.12 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$148.92 ,73% of billed charges for outpatient setting,$183.60 ,90% of billed charges for outpatient setting,$56.79 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$163.20 ,80% of billed charges for outpatient setting,$153.00 ,75% of billed charges for outpatient setting,$57.69 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$54.61 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$57.12 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$193.80 ,95% of billed charges for outpatient setting,$55.71 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$173.40 ,85% of billed charges for outpatient setting,$122.40 ,60% of billed charges for outpatient setting,$57.12 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$122.40 ,60% of billed charges for outpatient setting,$55.71 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$54.61 ,$193.80 ,$132.60 
Outpatient Medical Services,VISIT,99215,"Office Visit, Est Pt., Level 5",,$327.00 ,$219.09 ,67% of billed charges for outpatient setting,$91.56 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$87.54 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$91.56 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$238.71 ,73% of billed charges for outpatient setting,$294.30 ,90% of billed charges for outpatient setting,$91.04 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$261.60 ,80% of billed charges for outpatient setting,$245.25 ,75% of billed charges for outpatient setting,$92.48 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$87.54 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$91.56 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$310.65 ,95% of billed charges for outpatient setting,$89.30 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$277.95 ,85% of billed charges for outpatient setting,$196.20 ,60% of billed charges for outpatient setting,$91.56 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$196.20 ,60% of billed charges for outpatient setting,$89.30 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$87.54 ,$310.65 ,$212.55 
Outpatient Medical Services,VISIT,99202,"New patient office or other outpatient visit, typically 15 min",,$171.00 ,$114.57 ,67% of billed charges for outpatient setting,$47.88 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$45.78 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$47.88 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$124.83 ,73% of billed charges for outpatient setting,$153.90 ,90% of billed charges for outpatient setting,$47.61 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$136.80 ,80% of billed charges for outpatient setting,$128.25 ,75% of billed charges for outpatient setting,$48.36 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$45.78 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$47.88 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$162.45 ,95% of billed charges for outpatient setting,$46.70 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$145.35 ,85% of billed charges for outpatient setting,$102.60 ,60% of billed charges for outpatient setting,$47.88 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$102.60 ,60% of billed charges for outpatient setting,$46.70 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$45.78 ,$162.45 ,$111.15 
Outpatient Medical Services,VISIT,99203,"New patient office or other outpatient visit, typically 30 min",,$223.00 ,$149.41 ,67% of billed charges for outpatient setting,$62.44 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$59.70 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$62.44 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$162.79 ,73% of billed charges for outpatient setting,$200.70 ,90% of billed charges for outpatient setting,$62.09 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$178.40 ,80% of billed charges for outpatient setting,$167.25 ,75% of billed charges for outpatient setting,$63.06 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$59.70 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$62.44 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$211.85 ,95% of billed charges for outpatient setting,$60.90 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$189.55 ,85% of billed charges for outpatient setting,$133.80 ,60% of billed charges for outpatient setting,$62.44 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$133.80 ,60% of billed charges for outpatient setting,$60.90 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$59.70 ,$211.85 ,$144.95 
Outpatient Medical Services,VISIT,99204,"New patient office of other outpatient visit, typically 45 min",,$319.00 ,$213.73 ,67% of billed charges for outpatient setting,$89.32 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$85.40 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$89.32 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$232.87 ,73% of billed charges for outpatient setting,$287.10 ,90% of billed charges for outpatient setting,$88.82 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$255.20 ,80% of billed charges for outpatient setting,$239.25 ,75% of billed charges for outpatient setting,$90.21 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$85.40 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$89.32 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$303.05 ,95% of billed charges for outpatient setting,$87.12 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$271.15 ,85% of billed charges for outpatient setting,$191.40 ,60% of billed charges for outpatient setting,$89.32 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$191.40 ,60% of billed charges for outpatient setting,$87.12 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$85.40 ,$303.05 ,$207.35 
Outpatient Medical Services,VISIT,99205,"New patient office of other outpatient visit, typically 60 min",,$430.00 ,$288.10 ,67% of billed charges for outpatient setting,$120.40 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$115.11 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$120.40 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$313.90 ,73% of billed charges for outpatient setting,$387.00 ,90% of billed charges for outpatient setting,$119.71 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$344.00 ,80% of billed charges for outpatient setting,$322.50 ,75% of billed charges for outpatient setting,$121.60 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$115.11 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$120.40 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$408.50 ,95% of billed charges for outpatient setting,$117.43 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$365.50 ,85% of billed charges for outpatient setting,$258.00 ,60% of billed charges for outpatient setting,$120.40 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$258.00 ,60% of billed charges for outpatient setting,$117.43 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$115.11 ,$408.50 ,$279.50 
Outpatient Medical Services,VISIT,99243,"Patient office consultation, typically 40 min",,$269.00 ,$180.23 ,67% of billed charges for outpatient setting,$75.32 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$72.01 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$75.32 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$196.37 ,73% of billed charges for outpatient setting,$242.10 ,90% of billed charges for outpatient setting,$74.89 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$215.20 ,80% of billed charges for outpatient setting,$201.75 ,75% of billed charges for outpatient setting,$76.07 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$72.01 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$75.32 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$255.55 ,95% of billed charges for outpatient setting,$73.46 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$228.65 ,85% of billed charges for outpatient setting,$161.40 ,60% of billed charges for outpatient setting,$75.32 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$161.40 ,60% of billed charges for outpatient setting,$73.46 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$72.01 ,$255.55 ,$174.85 
Outpatient Medical Services,VISIT,99244,"Patient office consultation, typically 60 min",,$365.00 ,$244.55 ,67% of billed charges for outpatient setting,$102.20 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$97.71 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$102.20 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$266.45 ,73% of billed charges for outpatient setting,$328.50 ,90% of billed charges for outpatient setting,$101.62 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$292.00 ,80% of billed charges for outpatient setting,$273.75 ,75% of billed charges for outpatient setting,$103.22 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$97.71 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$102.20 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$346.75 ,95% of billed charges for outpatient setting,$99.68 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$310.25 ,85% of billed charges for outpatient setting,$219.00 ,60% of billed charges for outpatient setting,$102.20 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$219.00 ,60% of billed charges for outpatient setting,$99.68 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$97.71 ,$346.75 ,$237.25 
Outpatient Medical Services,VISIT,99384,Initial new patient preventive medicine evaluation (12-18 years),,$219.00 ,$146.73 ,67% of billed charges for outpatient setting,$61.32 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$58.63 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$61.32 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$159.87 ,73% of billed charges for outpatient setting,$197.10 ,90% of billed charges for outpatient setting,$60.98 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$175.20 ,80% of billed charges for outpatient setting,$164.25 ,75% of billed charges for outpatient setting,$61.93 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$58.63 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$61.32 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$208.05 ,95% of billed charges for outpatient setting,$59.81 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$186.15 ,85% of billed charges for outpatient setting,$131.40 ,60% of billed charges for outpatient setting,$61.32 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$131.40 ,60% of billed charges for outpatient setting,$59.81 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$58.63 ,$208.05 ,$142.35 
Outpatient Medical Services,VISIT,99385,Initial new patient preventive medicine evaluation (18-39 years),,$300.00 ,$201.00 ,67% of billed charges for outpatient setting,$84.00 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$80.31 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$84.00 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$219.00 ,73% of billed charges for outpatient setting,$270.00 ,90% of billed charges for outpatient setting,$83.52 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$240.00 ,80% of billed charges for outpatient setting,$225.00 ,75% of billed charges for outpatient setting,$84.84 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$80.31 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$84.00 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$285.00 ,95% of billed charges for outpatient setting,$81.93 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$255.00 ,85% of billed charges for outpatient setting,$180.00 ,60% of billed charges for outpatient setting,$84.00 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$180.00 ,60% of billed charges for outpatient setting,$81.93 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$80.31 ,$285.00 ,$195.00 
Outpatient Medical Services,VISIT,99386,Initial new patient preventive medicine evaluation (40-64 years),,$328.00 ,$219.76 ,67% of billed charges for outpatient setting,$91.84 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$87.81 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$91.84 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$239.44 ,73% of billed charges for outpatient setting,$295.20 ,90% of billed charges for outpatient setting,$91.32 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$262.40 ,80% of billed charges for outpatient setting,$246.00 ,75% of billed charges for outpatient setting,$92.76 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$87.81 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$91.84 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$311.60 ,95% of billed charges for outpatient setting,$89.58 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$278.80 ,85% of billed charges for outpatient setting,$196.80 ,60% of billed charges for outpatient setting,$91.84 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$196.80 ,60% of billed charges for outpatient setting,$89.58 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$87.81 ,$311.60 ,$213.20 
Outpatient Medical Services,RADIOLOGY,72040,CERVICAL SPINE 2-3 VIEWS,320,$723.58 ,$484.80 ,67% of billed charges for outpatient setting,$202.60 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$193.70 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$202.60 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$70.30 ,208% BCBS PPO fee schedule,$651.22 ,90% of billed charges for outpatient setting,$201.45 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$578.86 ,80% of billed charges for outpatient setting,$542.69 ,75% of billed charges for outpatient setting,$204.63 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$193.70 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$202.60 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$687.40 ,95% of billed charges for outpatient setting,$197.61 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$615.04 ,85% of billed charges for outpatient setting,$434.15 ,60% of billed charges for outpatient setting,$202.60 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$434.15 ,60% of billed charges for outpatient setting,$197.61 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$70.30 ,$687.40 ,$470.33 
Outpatient Medical Services,RADIOLOGY,71045,CHEST AP 1V,324,$490.01 ,$328.31 ,67% of billed charges for outpatient setting,$137.20 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$131.18 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$137.20 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$357.71 ,73% of billed charges for outpatient setting,$441.01 ,90% of billed charges for outpatient setting,$136.43 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$392.01 ,80% of billed charges for outpatient setting,$367.51 ,75% of billed charges for outpatient setting,$138.57 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$131.18 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$137.20 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$465.51 ,95% of billed charges for outpatient setting,$133.82 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$416.51 ,85% of billed charges for outpatient setting,$294.01 ,60% of billed charges for outpatient setting,$137.20 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$294.01 ,60% of billed charges for outpatient setting,$133.82 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$131.18 ,$465.51 ,$318.51 
Outpatient Medical Services,RADIOLOGY,74177,CT CHEST ABD/PEL W,352,"$5,502.00 ","$3,686.34 ",67% of billed charges for outpatient setting,"$1,540.56 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$1,472.89 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,540.56 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$666.64 ,208% BCBS PPO fee schedule,"$4,951.80 ",90% of billed charges for outpatient setting,"$1,531.81 ",29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$4,401.60 ",80% of billed charges for outpatient setting,"$4,126.50 ",75% of billed charges for outpatient setting,"$1,555.97 ",28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,"$1,472.89 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,540.56 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$5,226.90 ",95% of billed charges for outpatient setting,"$1,502.60 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$4,676.70 ",85% of billed charges for outpatient setting,"$3,301.20 ",60% of billed charges for outpatient setting,"$1,540.56 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$3,301.20 ",60% of billed charges for outpatient setting,"$1,502.60 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$666.64 ,"$5,226.90 ","$3,576.30 "
Outpatient Medical Services,RADIOLOGY,71250,CT CHEST W O CON,352,"$1,308.00 ",$876.36 ,67% of billed charges for outpatient setting,$366.24 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$350.15 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$366.24 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$405.31 ,208% BCBS PPO fee schedule,"$1,177.20 ",90% of billed charges for outpatient setting,$364.16 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$1,046.40 ",80% of billed charges for outpatient setting,$981.00 ,75% of billed charges for outpatient setting,$369.90 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$350.15 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$366.24 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$1,242.60 ",95% of billed charges for outpatient setting,$357.21 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$1,111.80 ",85% of billed charges for outpatient setting,$784.80 ,60% of billed charges for outpatient setting,$366.24 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$784.80 ,60% of billed charges for outpatient setting,$357.21 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$350.15 ,"$1,242.60 ",$850.20 
Outpatient Medical Services,RADIOLOGY,72125,CT C-SP W O CON,352,"$4,047.88 ","$2,712.08 ",67% of billed charges for outpatient setting,"$1,133.41 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$1,083.62 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,133.41 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$414.56 ,208% BCBS PPO fee schedule,"$3,643.09 ",90% of billed charges for outpatient setting,"$1,126.96 ",29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$3,238.30 ",80% of billed charges for outpatient setting,"$3,035.91 ",75% of billed charges for outpatient setting,"$1,144.74 ",28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,"$1,083.62 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,133.41 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$3,845.49 ",95% of billed charges for outpatient setting,"$1,105.48 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$3,440.70 ",85% of billed charges for outpatient setting,"$2,428.73 ",60% of billed charges for outpatient setting,"$1,133.41 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$2,428.73 ",60% of billed charges for outpatient setting,"$1,105.48 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$414.56 ,"$3,845.49 ","$2,631.12 "
Outpatient Medical Services,RADIOLOGY,70450,CT HEAD W O CONTRAST,351,"$3,442.74 ","$2,306.64 ",67% of billed charges for outpatient setting,$963.97 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$921.62 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$963.97 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$318.88 ,208% BCBS PPO fee schedule,"$3,098.47 ",90% of billed charges for outpatient setting,$958.48 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$2,754.19 ",80% of billed charges for outpatient setting,"$2,582.06 ",75% of billed charges for outpatient setting,$973.61 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$921.62 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$963.97 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$3,270.60 ",95% of billed charges for outpatient setting,$940.21 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$2,926.33 ",85% of billed charges for outpatient setting,"$2,065.64 ",60% of billed charges for outpatient setting,$963.97 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$2,065.64 ",60% of billed charges for outpatient setting,$940.21 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$318.88 ,"$3,270.60 ","$2,237.78 "
Outpatient Medical Services,RADIOLOGY,73700,CT LOW EXT L-W O CON,352,"$2,921.09 ","$1,957.13 ",67% of billed charges for outpatient setting,$817.91 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$781.98 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$817.91 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$404.56 ,208% BCBS PPO fee schedule,"$2,628.98 ",90% of billed charges for outpatient setting,$813.26 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$2,336.87 ",80% of billed charges for outpatient setting,"$2,190.82 ",75% of billed charges for outpatient setting,$826.08 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$781.98 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$817.91 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$2,775.04 ",95% of billed charges for outpatient setting,$797.75 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$2,482.93 ",85% of billed charges for outpatient setting,"$1,752.65 ",60% of billed charges for outpatient setting,$817.91 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$1,752.65 ",60% of billed charges for outpatient setting,$797.75 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$404.56 ,"$2,775.04 ","$1,898.71 "
Outpatient Medical Services,RADIOLOGY,72131,CT L-SP W O CON,352,"$3,614.55 ","$2,421.75 ",67% of billed charges for outpatient setting,"$1,012.07 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$967.62 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,012.07 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$404.52 ,208% BCBS PPO fee schedule,"$3,253.10 ",90% of billed charges for outpatient setting,"$1,006.32 ",29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$2,891.64 ",80% of billed charges for outpatient setting,"$2,710.91 ",75% of billed charges for outpatient setting,"$1,022.19 ",28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$967.62 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,012.07 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$3,433.82 ",95% of billed charges for outpatient setting,$987.13 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$3,072.37 ",85% of billed charges for outpatient setting,"$2,168.73 ",60% of billed charges for outpatient setting,"$1,012.07 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$2,168.73 ",60% of billed charges for outpatient setting,$987.13 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$404.52 ,"$3,433.82 ","$2,349.46 "
Outpatient Medical Services,RADIOLOGY,72193,CT PELVIS W CON,352,"$1,378.00 ",$923.26 ,67% of billed charges for outpatient setting,$385.84 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$368.89 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$385.84 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$527.74 ,208% BCBS PPO fee schedule,"$1,240.20 ",90% of billed charges for outpatient setting,$383.65 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$1,102.40 ",80% of billed charges for outpatient setting,"$1,033.50 ",75% of billed charges for outpatient setting,$389.70 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$368.89 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$385.84 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$1,309.10 ",95% of billed charges for outpatient setting,$376.33 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$1,171.30 ",85% of billed charges for outpatient setting,$826.80 ,60% of billed charges for outpatient setting,$385.84 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$826.80 ,60% of billed charges for outpatient setting,$376.33 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$368.89 ,"$1,309.10 ",$895.70 
Outpatient Medical Services,RADIOLOGY,73200,CT UP EXT L W O CON,352,"$2,917.20 ","$1,954.52 ",67% of billed charges for outpatient setting,$816.82 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$780.93 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$816.82 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$403.29 ,208% BCBS PPO fee schedule,"$2,625.48 ",90% of billed charges for outpatient setting,$812.17 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$2,333.76 ",80% of billed charges for outpatient setting,"$2,187.90 ",75% of billed charges for outpatient setting,$824.98 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$780.93 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$816.82 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$2,771.34 ",95% of billed charges for outpatient setting,$796.69 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$2,479.62 ",85% of billed charges for outpatient setting,"$1,750.32 ",60% of billed charges for outpatient setting,$816.82 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$1,750.32 ",60% of billed charges for outpatient setting,$796.69 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$403.29 ,"$2,771.34 ","$1,896.18 "
Outpatient Medical Services,RADIOLOGY,77080,DEXA BONE DENSITY AXIAL,320,$325.92 ,$218.37 ,67% of billed charges for outpatient setting,$91.26 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$87.25 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$91.26 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$95.53 ,208% BCBS PPO fee schedule,$293.33 ,90% of billed charges for outpatient setting,$90.74 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$260.74 ,80% of billed charges for outpatient setting,$244.44 ,75% of billed charges for outpatient setting,$92.17 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$87.25 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$91.26 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$309.62 ,95% of billed charges for outpatient setting,$89.01 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$277.03 ,85% of billed charges for outpatient setting,$195.55 ,60% of billed charges for outpatient setting,$91.26 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$195.55 ,60% of billed charges for outpatient setting,$89.01 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$87.25 ,$309.62 ,$211.85 
Outpatient Medical Services,RADIOLOGY,73080,ELBOW LT >3V,320,$654.98 ,$438.84 ,67% of billed charges for outpatient setting,$183.39 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$175.34 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$183.39 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$66.08 ,208% BCBS PPO fee schedule,$589.48 ,90% of billed charges for outpatient setting,$182.35 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$523.98 ,80% of billed charges for outpatient setting,$491.24 ,75% of billed charges for outpatient setting,$185.23 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$175.34 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$183.39 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$622.23 ,95% of billed charges for outpatient setting,$178.88 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$556.73 ,85% of billed charges for outpatient setting,$392.99 ,60% of billed charges for outpatient setting,$183.39 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$392.99 ,60% of billed charges for outpatient setting,$178.88 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$66.08 ,$622.23 ,$425.74 
Outpatient Medical Services,RADIOLOGY,74220,ESOPHAGRAM,320,$835.12 ,$559.53 ,67% of billed charges for outpatient setting,$233.83 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$223.56 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$233.83 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$178.80 ,208% BCBS PPO fee schedule,$751.61 ,90% of billed charges for outpatient setting,$232.50 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$668.10 ,80% of billed charges for outpatient setting,$626.34 ,75% of billed charges for outpatient setting,$236.17 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$223.56 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$233.83 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$793.36 ,95% of billed charges for outpatient setting,$228.07 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$709.85 ,85% of billed charges for outpatient setting,$501.07 ,60% of billed charges for outpatient setting,$233.83 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$501.07 ,60% of billed charges for outpatient setting,$228.07 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$178.80 ,$793.36 ,$542.83 
Outpatient Medical Services,RADIOLOGY,76000,FLUORO-UP TO 1 HOUR,320,"$1,551.00 ","$1,039.17 ",67% of billed charges for outpatient setting,$434.28 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$415.20 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$434.28 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$100.40 ,208% BCBS PPO fee schedule,"$1,395.90 ",90% of billed charges for outpatient setting,$431.81 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$1,240.80 ",80% of billed charges for outpatient setting,"$1,163.25 ",75% of billed charges for outpatient setting,$438.62 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$415.20 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$434.28 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$1,473.45 ",95% of billed charges for outpatient setting,$423.58 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$1,318.35 ",85% of billed charges for outpatient setting,$930.60 ,60% of billed charges for outpatient setting,$434.28 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$930.60 ,60% of billed charges for outpatient setting,$423.58 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$100.40 ,"$1,473.45 ","$1,008.15 "
Outpatient Medical Services,RADIOLOGY,73630,FOOT >3V,320,$621.16 ,$416.18 ,67% of billed charges for outpatient setting,$173.92 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$166.28 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$173.92 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$62.28 ,208% BCBS PPO fee schedule,$559.04 ,90% of billed charges for outpatient setting,$172.93 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$496.93 ,80% of billed charges for outpatient setting,$465.87 ,75% of billed charges for outpatient setting,$175.66 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$166.28 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$173.92 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$590.10 ,95% of billed charges for outpatient setting,$169.64 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$527.99 ,85% of billed charges for outpatient setting,$372.70 ,60% of billed charges for outpatient setting,$173.92 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$372.70 ,60% of billed charges for outpatient setting,$169.64 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$62.28 ,$590.10 ,$403.75 
Outpatient Medical Services,RADIOLOGY,73130,HAND >3V,320,$677.52 ,$453.94 ,67% of billed charges for outpatient setting,$189.71 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$181.37 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$189.71 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$64.17 ,208% BCBS PPO fee schedule,$609.77 ,90% of billed charges for outpatient setting,$188.62 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$542.02 ,80% of billed charges for outpatient setting,$508.14 ,75% of billed charges for outpatient setting,$191.60 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$181.37 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$189.71 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$643.64 ,95% of billed charges for outpatient setting,$185.03 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$575.89 ,85% of billed charges for outpatient setting,$406.51 ,60% of billed charges for outpatient setting,$189.71 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$406.51 ,60% of billed charges for outpatient setting,$185.03 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$64.17 ,$643.64 ,$440.39 
Outpatient Medical Services,RADIOLOGY,73120,HAND 2V,320,$210.24 ,$140.86 ,67% of billed charges for outpatient setting,$58.87 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$56.28 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$58.87 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$54.56 ,208% BCBS PPO fee schedule,$189.22 ,90% of billed charges for outpatient setting,$58.53 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$168.19 ,80% of billed charges for outpatient setting,$157.68 ,75% of billed charges for outpatient setting,$59.46 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$56.28 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$58.87 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$199.73 ,95% of billed charges for outpatient setting,$57.42 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$178.70 ,85% of billed charges for outpatient setting,$126.14 ,60% of billed charges for outpatient setting,$58.87 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$126.14 ,60% of billed charges for outpatient setting,$57.42 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$54.56 ,$199.73 ,$136.66 
Outpatient Medical Services,RADIOLOGY,73562,KNEE 3V,320,$726.44 ,$486.71 ,67% of billed charges for outpatient setting,$203.40 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$194.47 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$203.40 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$74.46 ,208% BCBS PPO fee schedule,$653.80 ,90% of billed charges for outpatient setting,$202.25 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$581.15 ,80% of billed charges for outpatient setting,$544.83 ,75% of billed charges for outpatient setting,$205.44 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$194.47 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$203.40 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$690.12 ,95% of billed charges for outpatient setting,$198.39 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$617.47 ,85% of billed charges for outpatient setting,$435.86 ,60% of billed charges for outpatient setting,$203.40 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$435.86 ,60% of billed charges for outpatient setting,$198.39 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$74.46 ,$690.12 ,$472.19 
Outpatient Medical Services,RADIOLOGY,72110,LUMBAR SPINE 4+ VIEWS,320,"$1,028.23 ",$688.91 ,67% of billed charges for outpatient setting,$287.90 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$275.26 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$287.90 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$96.37 ,208% BCBS PPO fee schedule,$925.41 ,90% of billed charges for outpatient setting,$286.27 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$822.58 ,80% of billed charges for outpatient setting,$771.17 ,75% of billed charges for outpatient setting,$290.78 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$275.26 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$287.90 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$976.82 ,95% of billed charges for outpatient setting,$280.81 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$874.00 ,85% of billed charges for outpatient setting,$616.94 ,60% of billed charges for outpatient setting,$287.90 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$616.94 ,60% of billed charges for outpatient setting,$280.81 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$96.37 ,$976.82 ,$668.35 
Outpatient Medical Services,RADIOLOGY,77066,MM DIAG DIGITAL BIL,401,$699.27 ,$468.51 ,67% of billed charges for outpatient setting,$195.80 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$187.19 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$195.80 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$510.47 ,73% of billed charges for outpatient setting,$629.34 ,90% of billed charges for outpatient setting,$194.68 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$559.42 ,80% of billed charges for outpatient setting,$524.45 ,75% of billed charges for outpatient setting,$197.75 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$187.19 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$195.80 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$664.31 ,95% of billed charges for outpatient setting,$190.97 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$594.38 ,85% of billed charges for outpatient setting,$419.56 ,60% of billed charges for outpatient setting,$195.80 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$419.56 ,60% of billed charges for outpatient setting,$190.97 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$187.19 ,$664.31 ,$454.53 
Outpatient Medical Services,RADIOLOGY,77065,MM MAM LT DIA/POSTMAST DIGITAL,401,$583.24 ,$390.77 ,67% of billed charges for outpatient setting,$163.31 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$156.13 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$163.31 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$425.77 ,73% of billed charges for outpatient setting,$524.92 ,90% of billed charges for outpatient setting,$162.38 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$466.59 ,80% of billed charges for outpatient setting,$437.43 ,75% of billed charges for outpatient setting,$164.94 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$156.13 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$163.31 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$554.08 ,95% of billed charges for outpatient setting,$159.28 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$495.75 ,85% of billed charges for outpatient setting,$349.94 ,60% of billed charges for outpatient setting,$163.31 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$349.94 ,60% of billed charges for outpatient setting,$159.28 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$156.13 ,$554.08 ,$379.11 
Outpatient Medical Services,RADIOLOGY,77067,MM MAM SCR DIGITAL,403,$606.32 ,$406.23 ,67% of billed charges for outpatient setting,$169.77 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$162.31 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$169.77 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$442.61 ,73% of billed charges for outpatient setting,$545.69 ,90% of billed charges for outpatient setting,$168.80 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$485.06 ,80% of billed charges for outpatient setting,$454.74 ,75% of billed charges for outpatient setting,$171.47 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$162.31 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$169.77 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$576.00 ,95% of billed charges for outpatient setting,$165.59 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$515.37 ,85% of billed charges for outpatient setting,$363.79 ,60% of billed charges for outpatient setting,$169.77 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$363.79 ,60% of billed charges for outpatient setting,$165.59 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$162.31 ,$576.00 ,$394.11 
Outpatient Medical Services,RADIOLOGY,72141,MRI C-SPINE W/O CONTRAST,612,"$4,598.34 ","$3,080.89 ",67% of billed charges for outpatient setting,"$1,287.54 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$1,230.98 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,287.54 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$734.97 ,208% BCBS PPO fee schedule,"$4,138.51 ",90% of billed charges for outpatient setting,"$1,280.22 ",29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$3,678.67 ",80% of billed charges for outpatient setting,"$3,448.76 ",75% of billed charges for outpatient setting,"$1,300.41 ",28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,"$1,230.98 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,287.54 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$4,368.42 ",95% of billed charges for outpatient setting,"$1,255.81 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$3,908.59 ",85% of billed charges for outpatient setting,"$2,759.00 ",60% of billed charges for outpatient setting,"$1,287.54 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$2,759.00 ",60% of billed charges for outpatient setting,"$1,255.81 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$734.97 ,"$4,368.42 ","$2,988.92 "
Outpatient Medical Services,RADIOLOGY,73718,MRI FEMUR/THIGH LT W/O CONTRAST,610,"$4,018.93 ","$2,692.68 ",67% of billed charges for outpatient setting,"$1,125.30 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$1,075.87 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,125.30 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$798.57 ,208% BCBS PPO fee schedule,"$3,617.04 ",90% of billed charges for outpatient setting,"$1,118.90 ",29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$3,215.14 ",80% of billed charges for outpatient setting,"$3,014.20 ",75% of billed charges for outpatient setting,"$1,136.55 ",28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,"$1,075.87 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,125.30 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$3,817.98 ",95% of billed charges for outpatient setting,"$1,097.57 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$3,416.09 ",85% of billed charges for outpatient setting,"$2,411.36 ",60% of billed charges for outpatient setting,"$1,125.30 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$2,411.36 ",60% of billed charges for outpatient setting,"$1,097.57 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$798.57 ,"$3,817.98 ","$2,612.30 "
Outpatient Medical Services,RADIOLOGY,70553,MRI HEAD W/W/O CONTRAST0,611,"$2,900.00 ","$1,943.00 ",67% of billed charges for outpatient setting,$812.00 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$776.33 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$812.00 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$1,085.61 ",208% BCBS PPO fee schedule,"$2,610.00 ",90% of billed charges for outpatient setting,$807.38 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$2,320.00 ",80% of billed charges for outpatient setting,"$2,175.00 ",75% of billed charges for outpatient setting,$820.12 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$776.33 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$812.00 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$2,755.00 ",95% of billed charges for outpatient setting,$791.99 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$2,465.00 ",85% of billed charges for outpatient setting,"$1,740.00 ",60% of billed charges for outpatient setting,$812.00 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$1,740.00 ",60% of billed charges for outpatient setting,$791.99 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$776.33 ,"$2,755.00 ","$1,885.00 "
Outpatient Medical Services,RADIOLOGY,73721,MRI KNEE RT W/O CONTRAST,610,"$2,143.00 ","$1,435.81 ",67% of billed charges for outpatient setting,$600.04 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$573.68 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$600.04 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$536.79 ,208% BCBS PPO fee schedule,"$1,928.70 ",90% of billed charges for outpatient setting,$596.63 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$1,714.40 ",80% of billed charges for outpatient setting,"$1,607.25 ",75% of billed charges for outpatient setting,$606.04 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$573.68 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$600.04 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$2,035.85 ",95% of billed charges for outpatient setting,$585.25 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$1,821.55 ",85% of billed charges for outpatient setting,"$1,285.80 ",60% of billed charges for outpatient setting,$600.04 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$1,285.80 ",60% of billed charges for outpatient setting,$585.25 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$536.79 ,"$2,035.85 ","$1,392.95 "
Outpatient Medical Services,RADIOLOGY,72148,MRI L-SPINE W/O CONTRAST,612,"$4,725.00 ","$3,165.75 ",67% of billed charges for outpatient setting,"$1,323.00 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$1,264.88 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,323.00 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$724.57 ,208% BCBS PPO fee schedule,"$4,252.50 ",90% of billed charges for outpatient setting,"$1,315.48 ",29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$3,780.00 ",80% of billed charges for outpatient setting,"$3,543.75 ",75% of billed charges for outpatient setting,"$1,336.23 ",28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,"$1,264.88 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,323.00 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$4,488.75 ",95% of billed charges for outpatient setting,"$1,290.40 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$4,016.25 ",85% of billed charges for outpatient setting,"$2,835.00 ",60% of billed charges for outpatient setting,"$1,323.00 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$2,835.00 ",60% of billed charges for outpatient setting,"$1,290.40 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$724.57 ,"$4,488.75 ","$3,071.25 "
Outpatient Medical Services,RADIOLOGY,73221,MRI SHOULDER RT W/O CONTRAST,610,"$4,024.02 ","$2,696.09 ",67% of billed charges for outpatient setting,"$1,126.73 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$1,077.23 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,126.73 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$536.79 ,208% BCBS PPO fee schedule,"$3,621.62 ",90% of billed charges for outpatient setting,"$1,120.32 ",29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$3,219.22 ",80% of billed charges for outpatient setting,"$3,018.02 ",75% of billed charges for outpatient setting,"$1,137.99 ",28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,"$1,077.23 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,126.73 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$3,822.82 ",95% of billed charges for outpatient setting,"$1,098.96 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$3,420.42 ",85% of billed charges for outpatient setting,"$2,414.41 ",60% of billed charges for outpatient setting,"$1,126.73 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$2,414.41 ",60% of billed charges for outpatient setting,"$1,098.96 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$536.79 ,"$3,822.82 ","$2,615.61 "
Outpatient Medical Services,RADIOLOGY,73222,MRI WRIST LT W/CONTRAST,610,"$5,482.62 ","$3,673.36 ",67% of billed charges for outpatient setting,"$1,535.13 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$1,467.70 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,535.13 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$838.70 ,208% BCBS PPO fee schedule,"$4,934.36 ",90% of billed charges for outpatient setting,"$1,526.41 ",29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$4,386.10 ",80% of billed charges for outpatient setting,"$4,111.97 ",75% of billed charges for outpatient setting,"$1,550.48 ",28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,"$1,467.70 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,535.13 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$5,208.49 ",95% of billed charges for outpatient setting,"$1,497.30 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$4,660.23 ",85% of billed charges for outpatient setting,"$3,289.57 ",60% of billed charges for outpatient setting,"$1,535.13 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$3,289.57 ",60% of billed charges for outpatient setting,"$1,497.30 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$838.70 ,"$5,208.49 ","$3,563.70 "
Outpatient Medical Services,RADIOLOGY,78815,PET IMAGING EYES -MID THIGH,404,"$7,138.00 ","$4,782.46 ",67% of billed charges for outpatient setting,"$1,998.64 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$1,910.84 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,998.64 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,,Not separately reimbursable,"$6,424.20 ",90% of billed charges for outpatient setting,"$1,987.27 ",29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$5,710.40 ",80% of billed charges for outpatient setting,"$5,353.50 ",75% of billed charges for outpatient setting,"$2,018.63 ",28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,"$1,910.84 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,998.64 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$6,781.10 ",95% of billed charges for outpatient setting,"$1,949.39 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$6,067.30 ",85% of billed charges for outpatient setting,"$4,282.80 ",60% of billed charges for outpatient setting,"$1,998.64 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$4,282.80 ",60% of billed charges for outpatient setting,"$1,949.39 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$1,910.84 ","$6,781.10 ","$4,639.70 "
Outpatient Medical Services,RADIOLOGY,73030,SHOULDER 2+ VIEWS,320,$668.23 ,$447.71 ,67% of billed charges for outpatient setting,$187.10 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$178.89 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$187.10 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$61.11 ,208% BCBS PPO fee schedule,$601.41 ,90% of billed charges for outpatient setting,$186.05 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$534.58 ,80% of billed charges for outpatient setting,$501.17 ,75% of billed charges for outpatient setting,$188.98 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$178.89 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$187.10 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$634.82 ,95% of billed charges for outpatient setting,$182.49 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$568.00 ,85% of billed charges for outpatient setting,$400.94 ,60% of billed charges for outpatient setting,$187.10 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$400.94 ,60% of billed charges for outpatient setting,$182.49 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$61.11 ,$634.82 ,$434.35 
Outpatient Medical Services,RADIOLOGY,76700,US ABDOMEN,402,"$1,625.91 ","$1,089.36 ",67% of billed charges for outpatient setting,$455.25 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$435.26 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$455.25 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$273.48 ,208% BCBS PPO fee schedule,"$1,463.32 ",90% of billed charges for outpatient setting,$452.67 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$1,300.73 ",80% of billed charges for outpatient setting,"$1,219.43 ",75% of billed charges for outpatient setting,$459.81 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$435.26 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$455.25 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$1,544.61 ",95% of billed charges for outpatient setting,$444.04 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$1,382.02 ",85% of billed charges for outpatient setting,$975.55 ,60% of billed charges for outpatient setting,$455.25 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$975.55 ,60% of billed charges for outpatient setting,$444.04 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$273.48 ,"$1,544.61 ","$1,056.84 "
Outpatient Medical Services,RADIOLOGY,76805,US FETAL STUDY COMPLETE,402,$841.00 ,$563.47 ,67% of billed charges for outpatient setting,$235.48 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$225.14 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$235.48 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$288.75 ,208% BCBS PPO fee schedule,$756.90 ,90% of billed charges for outpatient setting,$234.15 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$672.80 ,80% of billed charges for outpatient setting,$630.75 ,75% of billed charges for outpatient setting,$237.83 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$225.14 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$235.48 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$798.95 ,95% of billed charges for outpatient setting,$229.68 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$714.85 ,85% of billed charges for outpatient setting,$504.60 ,60% of billed charges for outpatient setting,$235.48 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$504.60 ,60% of billed charges for outpatient setting,$229.68 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$225.14 ,$798.95 ,$546.65 
Outpatient Medical Services,RADIOLOGY,10005,US GUIDED FNA,402,"$3,497.00 ","$2,342.99 ",67% of billed charges for outpatient setting,$979.16 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$936.15 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$979.16 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$2,552.81 ",73% of billed charges for outpatient setting,"$3,147.30 ",90% of billed charges for outpatient setting,$973.60 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$2,797.60 ",80% of billed charges for outpatient setting,"$2,622.75 ",75% of billed charges for outpatient setting,$988.95 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$936.15 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$979.16 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$3,322.15 ",95% of billed charges for outpatient setting,$955.03 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$2,972.45 ",85% of billed charges for outpatient setting,"$2,098.20 ",60% of billed charges for outpatient setting,$979.16 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$2,098.20 ",60% of billed charges for outpatient setting,$955.03 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$936.15 ,"$3,322.15 ","$2,273.05 "
Outpatient Medical Services,RADIOLOGY,49083,US PARACENTESIS,350,$830.00 ,$556.10 ,67% of billed charges for outpatient setting,$232.40 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$222.19 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$232.40 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$605.90 ,73% of billed charges for outpatient setting,$747.00 ,90% of billed charges for outpatient setting,$231.08 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$664.00 ,80% of billed charges for outpatient setting,$622.50 ,75% of billed charges for outpatient setting,$234.72 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$222.19 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$232.40 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$788.50 ,95% of billed charges for outpatient setting,$226.67 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$705.50 ,85% of billed charges for outpatient setting,$498.00 ,60% of billed charges for outpatient setting,$232.40 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$498.00 ,60% of billed charges for outpatient setting,$226.67 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$222.19 ,$788.50 ,$539.50 
Outpatient Medical Services,RADIOLOGY,76536,US SOFT TISSUE NECK AND HEAD,402,"$1,072.50 ",$718.58 ,67% of billed charges for outpatient setting,$300.30 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$287.11 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$300.30 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$237.35 ,208% BCBS PPO fee schedule,$965.25 ,90% of billed charges for outpatient setting,$298.59 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$858.00 ,80% of billed charges for outpatient setting,$804.38 ,75% of billed charges for outpatient setting,$303.30 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$287.11 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$300.30 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$1,018.88 ",95% of billed charges for outpatient setting,$292.90 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$911.63 ,85% of billed charges for outpatient setting,$643.50 ,60% of billed charges for outpatient setting,$300.30 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$643.50 ,60% of billed charges for outpatient setting,$292.90 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$237.35 ,"$1,018.88 ",$697.13 
Outpatient Medical Services,RADIOLOGY,76870,US TESTICULAR,402,"$1,387.10 ",$929.36 ,67% of billed charges for outpatient setting,$388.39 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$371.33 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$388.39 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$241.76 ,208% BCBS PPO fee schedule,"$1,248.39 ",90% of billed charges for outpatient setting,$386.18 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$1,109.68 ",80% of billed charges for outpatient setting,"$1,040.33 ",75% of billed charges for outpatient setting,$392.27 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$371.33 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$388.39 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$1,317.75 ",95% of billed charges for outpatient setting,$378.82 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$1,179.04 ",85% of billed charges for outpatient setting,$832.26 ,60% of billed charges for outpatient setting,$388.39 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$832.26 ,60% of billed charges for outpatient setting,$378.82 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$241.76 ,"$1,317.75 ",$901.62 
Outpatient Medical Services,RADIOLOGY,76830,US TRANSVAG NON OB,402,$960.96 ,$643.84 ,67% of billed charges for outpatient setting,$269.07 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$257.25 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$269.07 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$147.41 ,208% BCBS PPO fee schedule,$864.86 ,90% of billed charges for outpatient setting,$267.54 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$768.77 ,80% of billed charges for outpatient setting,$720.72 ,75% of billed charges for outpatient setting,$271.76 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$257.25 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$269.07 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$912.91 ,95% of billed charges for outpatient setting,$262.44 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$816.82 ,85% of billed charges for outpatient setting,$576.58 ,60% of billed charges for outpatient setting,$269.07 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$576.58 ,60% of billed charges for outpatient setting,$262.44 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$147.41 ,$912.91 ,$624.62 
Outpatient Medical Services,AMBULATORY,36600,ARTERIAL PUNCTURE,410,$118.56 ,$79.44 ,67% of billed charges for outpatient setting,$33.20 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$31.74 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$33.20 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$86.55 ,73% of billed charges for outpatient setting,$106.70 ,90% of billed charges for outpatient setting,$33.01 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$94.85 ,80% of billed charges for outpatient setting,$88.92 ,75% of billed charges for outpatient setting,$33.53 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$31.74 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$33.20 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$112.63 ,95% of billed charges for outpatient setting,$32.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$100.78 ,85% of billed charges for outpatient setting,$71.14 ,60% of billed charges for outpatient setting,$33.20 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$71.14 ,60% of billed charges for outpatient setting,$32.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$31.74 ,$112.63 ,$77.06 
Outpatient Medical Services,AMBULATORY,36430,BLOOD TRANSFUSION,391,$352.17 ,$235.95 ,67% of billed charges for outpatient setting,$98.61 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$94.28 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$98.61 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$257.08 ,73% of billed charges for outpatient setting,$316.95 ,90% of billed charges for outpatient setting,$98.05 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$281.74 ,80% of billed charges for outpatient setting,$264.13 ,75% of billed charges for outpatient setting,$99.59 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$94.28 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$98.61 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$334.56 ,95% of billed charges for outpatient setting,$96.18 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$299.34 ,85% of billed charges for outpatient setting,$211.30 ,60% of billed charges for outpatient setting,$98.61 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$211.30 ,60% of billed charges for outpatient setting,$96.18 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$94.28 ,$334.56 ,$228.91 
Outpatient Medical Services,AMBULATORY,66984,CATARACT REM W/INSERT IOL EXTRACAPSULAR,360,"$3,376.80 ","$2,262.46 ",67% of billed charges for outpatient setting,$945.50 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$903.97 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$945.50 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$2,465.06 ",73% of billed charges for outpatient setting,"$3,039.12 ",90% of billed charges for outpatient setting,$940.13 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$2,701.44 ",80% of billed charges for outpatient setting,"$2,532.60 ",75% of billed charges for outpatient setting,$954.96 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$903.97 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$945.50 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$3,207.96 ",95% of billed charges for outpatient setting,$922.20 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$2,870.28 ",85% of billed charges for outpatient setting,"$2,026.08 ",60% of billed charges for outpatient setting,$945.50 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$2,026.08 ",60% of billed charges for outpatient setting,$922.20 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$903.97 ,"$3,207.96 ","$2,194.92 "
Outpatient Medical Services,AMBULATORY,45380,COLONOSCOPY FLEX  W BX; SGL/MULTI COLD,750,"$4,431.83 ","$2,969.33 ",67% of billed charges for outpatient setting,"$1,240.91 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$1,186.40 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,240.91 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$3,235.24 ",73% of billed charges for outpatient setting,"$3,988.65 ",90% of billed charges for outpatient setting,"$1,233.86 ",29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$3,545.46 ",80% of billed charges for outpatient setting,"$3,323.87 ",75% of billed charges for outpatient setting,"$1,253.32 ",28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,"$1,186.40 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,240.91 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$4,210.24 ",95% of billed charges for outpatient setting,"$1,210.33 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$3,767.06 ",85% of billed charges for outpatient setting,"$2,659.10 ",60% of billed charges for outpatient setting,"$1,240.91 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$2,659.10 ",60% of billed charges for outpatient setting,"$1,210.33 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$1,186.40 ","$4,210.24 ","$2,880.69 "
Outpatient Medical Services,AMBULATORY,45385,"COLONOSCOPY FLEX W/ REM T/P/L , SNARECOL",750,"$3,800.94 ","$2,546.63 ",67% of billed charges for outpatient setting,"$1,064.26 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$1,017.51 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,064.26 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$2,774.69 ",73% of billed charges for outpatient setting,"$3,420.85 ",90% of billed charges for outpatient setting,"$1,058.21 ",29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$3,040.75 ",80% of billed charges for outpatient setting,"$2,850.71 ",75% of billed charges for outpatient setting,"$1,074.91 ",28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,"$1,017.51 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,064.26 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$3,610.89 ",95% of billed charges for outpatient setting,"$1,038.04 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$3,230.80 ",85% of billed charges for outpatient setting,"$2,280.56 ",60% of billed charges for outpatient setting,"$1,064.26 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$2,280.56 ",60% of billed charges for outpatient setting,"$1,038.04 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$1,017.51 ","$3,610.89 ","$2,470.61 "
Outpatient Medical Services,AMBULATORY,45384,COLONOSCOPY FLEX W/ REM T/P/L BY HOT BX,750,"$1,065.19 ",$713.68 ,67% of billed charges for outpatient setting,$298.25 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$285.15 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$298.25 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$777.59 ,73% of billed charges for outpatient setting,$958.67 ,90% of billed charges for outpatient setting,$296.56 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$852.15 ,80% of billed charges for outpatient setting,$798.89 ,75% of billed charges for outpatient setting,$301.24 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$285.15 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$298.25 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$1,011.93 ",95% of billed charges for outpatient setting,$290.90 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$905.41 ,85% of billed charges for outpatient setting,$639.11 ,60% of billed charges for outpatient setting,$298.25 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$639.11 ,60% of billed charges for outpatient setting,$290.90 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$285.15 ,"$1,011.93 ",$692.37 
Outpatient Medical Services,AMBULATORY,45378,COLONOSCOPY FLEXIBLE DIAGNOSTIC,750,"$3,640.78 ","$2,439.32 ",67% of billed charges for outpatient setting,"$1,019.42 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$974.64 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,019.42 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$2,657.77 ",73% of billed charges for outpatient setting,"$3,276.70 ",90% of billed charges for outpatient setting,"$1,013.63 ",29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$2,912.62 ",80% of billed charges for outpatient setting,"$2,730.59 ",75% of billed charges for outpatient setting,"$1,029.61 ",28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$974.64 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,019.42 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$3,458.74 ",95% of billed charges for outpatient setting,$994.30 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$3,094.66 ",85% of billed charges for outpatient setting,"$2,184.47 ",60% of billed charges for outpatient setting,"$1,019.42 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$2,184.47 ",60% of billed charges for outpatient setting,$994.30 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$974.64 ,"$3,458.74 ","$2,366.51 "
Outpatient Medical Services,AMBULATORY,G0105,COLONOSCOPY SCREENING HIGH RISK,750,"$4,059.77 ","$2,720.05 ",67% of billed charges for outpatient setting,"$1,136.74 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$1,086.80 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,136.74 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$2,963.63 ",73% of billed charges for outpatient setting,"$3,653.79 ",90% of billed charges for outpatient setting,"$1,130.27 ",29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$3,247.82 ",80% of billed charges for outpatient setting,"$3,044.83 ",75% of billed charges for outpatient setting,"$1,148.10 ",28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,"$1,086.80 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,136.74 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$3,856.78 ",95% of billed charges for outpatient setting,"$1,108.72 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$3,450.80 ",85% of billed charges for outpatient setting,"$2,435.86 ",60% of billed charges for outpatient setting,"$1,136.74 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$2,435.86 ",60% of billed charges for outpatient setting,"$1,108.72 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$1,086.80 ","$3,856.78 ","$2,638.85 "
Outpatient Medical Services,AMBULATORY,G0121,COLONOSCOPY SCREENING NOT HIGH RISK,750,"$4,065.49 ","$2,723.88 ",67% of billed charges for outpatient setting,"$1,138.34 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$1,088.33 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,138.34 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$2,967.81 ",73% of billed charges for outpatient setting,"$3,658.94 ",90% of billed charges for outpatient setting,"$1,131.86 ",29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$3,252.39 ",80% of billed charges for outpatient setting,"$3,049.12 ",75% of billed charges for outpatient setting,"$1,149.72 ",28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,"$1,088.33 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,138.34 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$3,862.22 ",95% of billed charges for outpatient setting,"$1,110.29 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$3,455.67 ",85% of billed charges for outpatient setting,"$2,439.29 ",60% of billed charges for outpatient setting,"$1,138.34 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$2,439.29 ",60% of billed charges for outpatient setting,"$1,110.29 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$1,088.33 ","$3,862.22 ","$2,642.57 "
Outpatient Medical Services,AMBULATORY,43235,EGD DIAGNOSTIC BRUSH WASH,750,"$3,258.97 ","$2,183.51 ",67% of billed charges for outpatient setting,$912.51 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$872.43 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$912.51 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$2,379.05 ",73% of billed charges for outpatient setting,"$2,933.07 ",90% of billed charges for outpatient setting,$907.33 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$2,607.18 ",80% of billed charges for outpatient setting,"$2,444.23 ",75% of billed charges for outpatient setting,$921.64 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$872.43 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$912.51 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$3,096.02 ",95% of billed charges for outpatient setting,$890.02 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$2,770.12 ",85% of billed charges for outpatient setting,"$1,955.38 ",60% of billed charges for outpatient setting,$912.51 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$1,955.38 ",60% of billed charges for outpatient setting,$890.02 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$872.43 ,"$3,096.02 ","$2,118.33 "
Outpatient Medical Services,AMBULATORY,43239,EGD W/BIOPSY SINGLE OR MULTI,750,"$3,575.00 ","$2,395.25 ",67% of billed charges for outpatient setting,"$1,001.00 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$957.03 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,001.00 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$2,609.75 ",73% of billed charges for outpatient setting,"$3,217.50 ",90% of billed charges for outpatient setting,$995.31 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$2,860.00 ",80% of billed charges for outpatient setting,"$2,681.25 ",75% of billed charges for outpatient setting,"$1,011.01 ",28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$957.03 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,001.00 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$3,396.25 ",95% of billed charges for outpatient setting,$976.33 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$3,038.75 ",85% of billed charges for outpatient setting,"$2,145.00 ",60% of billed charges for outpatient setting,"$1,001.00 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$2,145.00 ",60% of billed charges for outpatient setting,$976.33 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$957.03 ,"$3,396.25 ","$2,323.75 "
Outpatient Medical Services,AMBULATORY,19120,EXCISIONAL BIOPSY OF BREAST CANCER,975,"$1,356.00 ",N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,$306.21 ,100% GA Medicaid fee schedule for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,$318.46 ,104% GA Medicaid fee schedule for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,$306.21 ,100% GA Medicaid fee schedule for physician setting,N/A,Not separately reimbursable for physician setting,N/A,95% of billed charges for outpatient setting,$312.33 ,102% GA Medicaid fee schedule for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,$312.33 ,102% GA Medicaid fee schedule for physician setting,$306.21 ,$318.46 ,$881.40 
Outpatient Medical Services,AMBULATORY,29881,KNEE ARTHROSCOPY CHONDROMALACIA,975,"$3,229.00 ",N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,$532.13 ,100% GA Medicaid fee schedule for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,$553.42 ,104% GA Medicaid fee schedule for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,$532.13 ,100% GA Medicaid fee schedule for physician setting,N/A,Not separately reimbursable for physician setting,N/A,95% of billed charges for outpatient setting,$542.77 ,102% GA Medicaid fee schedule for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,$542.77 ,102% GA Medicaid fee schedule for physician setting,$532.13 ,$553.42 ,"$2,098.85 "
Outpatient Medical Services,AMBULATORY,64447,NERVE BLOCK LOWER,361,"$1,357.07 ",$909.24 ,67% of billed charges for outpatient setting,$379.98 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$363.29 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$379.98 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$990.66 ,73% of billed charges for outpatient setting,"$1,221.36 ",90% of billed charges for outpatient setting,$377.82 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$1,085.66 ",80% of billed charges for outpatient setting,"$1,017.80 ",75% of billed charges for outpatient setting,$383.78 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$363.29 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$379.98 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$1,289.22 ",95% of billed charges for outpatient setting,$370.62 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$1,153.51 ",85% of billed charges for outpatient setting,$814.24 ,60% of billed charges for outpatient setting,$379.98 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$814.24 ,60% of billed charges for outpatient setting,$370.62 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$363.29 ,"$1,289.22 ",$882.10 
Outpatient Medical Services,AMBULATORY,64418,NERVE BLOCK UPPER,370,"$1,551.55 ","$1,039.54 ",67% of billed charges for outpatient setting,$434.43 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$415.35 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$434.43 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$1,132.63 ",73% of billed charges for outpatient setting,"$1,396.40 ",90% of billed charges for outpatient setting,$431.96 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$1,241.24 ",80% of billed charges for outpatient setting,"$1,163.66 ",75% of billed charges for outpatient setting,$438.78 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$415.35 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$434.43 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$1,473.97 ",95% of billed charges for outpatient setting,$423.73 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$1,318.82 ",85% of billed charges for outpatient setting,$930.93 ,60% of billed charges for outpatient setting,$434.43 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$930.93 ,60% of billed charges for outpatient setting,$423.73 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$415.35 ,"$1,473.97 ","$1,008.51 "
Outpatient Medical Services,AMBULATORY,64635,RADIO FREQUENCY ABLATION PROC-LUMBAR,360,"$3,146.00 ","$2,107.82 ",67% of billed charges for outpatient setting,$880.88 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$842.18 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$880.88 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$2,296.58 ",73% of billed charges for outpatient setting,"$2,831.40 ",90% of billed charges for outpatient setting,$875.87 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$2,516.80 ",80% of billed charges for outpatient setting,"$2,359.50 ",75% of billed charges for outpatient setting,$889.69 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$842.18 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$880.88 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$2,988.70 ",95% of billed charges for outpatient setting,$859.17 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$2,674.10 ",85% of billed charges for outpatient setting,"$1,887.60 ",60% of billed charges for outpatient setting,$880.88 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$1,887.60 ",60% of billed charges for outpatient setting,$859.17 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$842.18 ,"$2,988.70 ","$2,044.90 "
Outpatient Medical Services,AMBULATORY,29826,SHOULDER ARTHROSCOPY,975,"$3,403.00 ",N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,$632.32 ,100% GA Medicaid fee schedule for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,$657.61 ,104% GA Medicaid fee schedule for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,$632.32 ,100% GA Medicaid fee schedule for physician setting,N/A,Not separately reimbursable for physician setting,N/A,95% of billed charges for outpatient setting,$644.97 ,102% GA Medicaid fee schedule for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,$644.97 ,102% GA Medicaid fee schedule for physician setting,$632.32 ,$657.61 ,"$2,211.95 "
Outpatient Medical Services,AMBULATORY,45391,"SIGMOIDOSCOPY FLEXIBLEW/ BX 1 OR MORE, C",,"$3,872.00 ","$2,594.24 ",67% of billed charges for outpatient setting,"$1,084.16 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$1,036.53 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,084.16 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$2,826.56 ",73% of billed charges for outpatient setting,"$3,484.80 ",90% of billed charges for outpatient setting,"$1,077.99 ",29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$3,097.60 ",80% of billed charges for outpatient setting,"$2,904.00 ",75% of billed charges for outpatient setting,"$1,095.00 ",28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,"$1,036.53 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,084.16 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$3,678.40 ",95% of billed charges for outpatient setting,"$1,057.44 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$3,291.20 ",85% of billed charges for outpatient setting,"$2,323.20 ",60% of billed charges for outpatient setting,"$1,084.16 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$2,323.20 ",60% of billed charges for outpatient setting,"$1,057.44 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$1,036.53 ","$3,678.40 ","$2,516.80 "
Outpatient Medical Services,THERAPY,97110,OT THERAPEUTIC EXERCISE (15 MIN),430,$172.52 ,$115.59 ,67% of billed charges for outpatient setting,$48.31 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$46.18 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$48.31 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$125.94 ,73% of billed charges for outpatient setting,$155.27 ,90% of billed charges for outpatient setting,$48.03 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$138.02 ,80% of billed charges for outpatient setting,$129.39 ,75% of billed charges for outpatient setting,$48.79 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$46.18 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$48.31 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$163.89 ,95% of billed charges for outpatient setting,$47.12 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$146.64 ,85% of billed charges for outpatient setting,$103.51 ,60% of billed charges for outpatient setting,$48.31 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$103.51 ,60% of billed charges for outpatient setting,$47.12 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$46.18 ,$163.89 ,$112.14 
Outpatient Medical Services,THERAPY,97161,PT EVALUATION LOW COMPLEXITY 20 MIN,424,$350.00 ,$234.50 ,67% of billed charges for outpatient setting,$98.00 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$93.70 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$98.00 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$255.50 ,73% of billed charges for outpatient setting,$315.00 ,90% of billed charges for outpatient setting,$97.45 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$280.00 ,80% of billed charges for outpatient setting,$262.50 ,75% of billed charges for outpatient setting,$98.98 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$93.70 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$98.00 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$332.50 ,95% of billed charges for outpatient setting,$95.59 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$297.50 ,85% of billed charges for outpatient setting,$210.00 ,60% of billed charges for outpatient setting,$98.00 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$210.00 ,60% of billed charges for outpatient setting,$95.59 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$93.70 ,$332.50 ,$227.50 
Outpatient Medical Services,THERAPY,97110,PT THERAPEUTIC EXERCISE (15 MIN),420,$172.52 ,$115.59 ,67% of billed charges for outpatient setting,$48.31 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$46.18 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$48.31 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$125.94 ,73% of billed charges for outpatient setting,$155.27 ,90% of billed charges for outpatient setting,$48.03 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$138.02 ,80% of billed charges for outpatient setting,$129.39 ,75% of billed charges for outpatient setting,$48.79 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$46.18 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$48.31 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$163.89 ,95% of billed charges for outpatient setting,$47.12 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$146.64 ,85% of billed charges for outpatient setting,$103.51 ,60% of billed charges for outpatient setting,$48.31 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$103.51 ,60% of billed charges for outpatient setting,$47.12 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$46.18 ,$163.89 ,$112.14 
Outpatient Medical Services,THERAPY,92610,ST CLINICAL EVALUATION OF SWALLOWING,440,$246.72 ,$165.30 ,67% of billed charges for outpatient setting,$69.08 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$66.05 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$69.08 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$180.11 ,73% of billed charges for outpatient setting,$222.05 ,90% of billed charges for outpatient setting,$68.69 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$197.38 ,80% of billed charges for outpatient setting,$185.04 ,75% of billed charges for outpatient setting,$69.77 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$66.05 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$69.08 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$234.38 ,95% of billed charges for outpatient setting,$67.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$209.71 ,85% of billed charges for outpatient setting,$148.03 ,60% of billed charges for outpatient setting,$69.08 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$148.03 ,60% of billed charges for outpatient setting,$67.38 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$66.05 ,$234.38 ,$160.37 
Outpatient Medical Services,SLEEP,95810,INITIAL SLEEP STUDY,410,"$5,672.08 ","$3,800.29 ",67% of billed charges for outpatient setting,"$1,588.18 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$1,518.42 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,588.18 ",28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$4,140.62 ",73% of billed charges for outpatient setting,"$5,104.87 ",90% of billed charges for outpatient setting,"$1,579.16 ",29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$4,537.66 ",80% of billed charges for outpatient setting,"$4,254.06 ",75% of billed charges for outpatient setting,"$1,604.06 ",28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,"$1,518.42 ",26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,"$1,588.18 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$5,388.48 ",95% of billed charges for outpatient setting,"$1,549.05 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$4,821.27 ",85% of billed charges for outpatient setting,"$3,403.25 ",60% of billed charges for outpatient setting,"$1,588.18 ",28% of total billed charges which is 100% GA Medicaid outpatient rate,"$3,403.25 ",60% of billed charges for outpatient setting,"$1,549.05 ",28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$1,518.42 ","$5,388.48 ","$3,686.85 "
Outpatient Medical Services,EMERGENCY ROOM,99281,EMERGENCY ROOM CLASS I,450,$568.00 ,$380.56 ,67% of billed charges for outpatient setting,$159.04 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$50.00 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$159.04 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$340.00 ,100% BCBS ER case rate,$511.20 ,90% of billed charges for outpatient setting,$158.13 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$454.40 ,80% of billed charges for outpatient setting,$426.00 ,75% of billed charges for outpatient setting,$160.63 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$152.05 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$159.04 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$539.60 ,95% of billed charges for outpatient setting,$155.09 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$482.80 ,85% of billed charges for outpatient setting,$340.80 ,60% of billed charges for outpatient setting,$159.04 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$340.80 ,60% of billed charges for outpatient setting,$155.09 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$50.00 ,$539.60 ,$369.20 
Outpatient Medical Services,EMERGENCY ROOM,99282,EMERGENCY ROOM CLASS II,450,$893.00 ,$598.31 ,67% of billed charges for outpatient setting,$250.04 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$239.06 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$250.04 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$340.00 ,100% BCBS ER case rate,$803.70 ,90% of billed charges for outpatient setting,$248.62 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$714.40 ,80% of billed charges for outpatient setting,$669.75 ,75% of billed charges for outpatient setting,$252.54 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$239.06 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$250.04 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$848.35 ,95% of billed charges for outpatient setting,$243.84 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$759.05 ,85% of billed charges for outpatient setting,$535.80 ,60% of billed charges for outpatient setting,$250.04 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$535.80 ,60% of billed charges for outpatient setting,$243.84 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$239.06 ,$848.35 ,$580.45 
Outpatient Medical Services,EMERGENCY ROOM,99283,EMERGENCY ROOM CLASS III,450,"$1,064.00 ",$712.88 ,67% of billed charges for outpatient setting,$297.92 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$284.83 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$297.92 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$683.00 ,100% BCBS ER case rate,$957.60 ,90% of billed charges for outpatient setting,$296.22 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$851.20 ,80% of billed charges for outpatient setting,$798.00 ,75% of billed charges for outpatient setting,$300.90 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$284.83 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$297.92 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$1,010.80 ",95% of billed charges for outpatient setting,$290.53 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$904.40 ,85% of billed charges for outpatient setting,$638.40 ,60% of billed charges for outpatient setting,$297.92 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$638.40 ,60% of billed charges for outpatient setting,$290.53 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$284.83 ,"$1,010.80 ",$691.60 
Outpatient Medical Services,EMERGENCY ROOM,99284,EMERGENCY ROOM CLASS IV,450,"$1,556.00 ","$1,042.52 ",67% of billed charges for outpatient setting,$435.68 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$416.54 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$435.68 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$683.00 ,100% BCBS ER case rate,"$1,400.40 ",90% of billed charges for outpatient setting,$433.20 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$1,244.80 ",80% of billed charges for outpatient setting,"$1,167.00 ",75% of billed charges for outpatient setting,$440.04 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$416.54 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$435.68 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$1,478.20 ",95% of billed charges for outpatient setting,$424.87 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$1,322.60 ",85% of billed charges for outpatient setting,$933.60 ,60% of billed charges for outpatient setting,$435.68 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$933.60 ,60% of billed charges for outpatient setting,$424.87 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$416.54 ,"$1,478.20 ","$1,011.40 "
Outpatient Medical Services,EMERGENCY ROOM,99285,EMERGENCY ROOM CLASS V,450,"$2,067.00 ","$1,384.89 ",67% of billed charges for outpatient setting,$578.76 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$553.34 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$578.76 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$1,400.00 ",100% BCBS ER case rate,"$1,860.30 ",90% of billed charges for outpatient setting,$575.47 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$1,653.60 ",80% of billed charges for outpatient setting,"$1,550.25 ",75% of billed charges for outpatient setting,$584.55 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$553.34 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$578.76 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$1,963.65 ",95% of billed charges for outpatient setting,$564.41 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$1,756.95 ",85% of billed charges for outpatient setting,"$1,240.20 ",60% of billed charges for outpatient setting,$578.76 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$1,240.20 ",60% of billed charges for outpatient setting,$564.41 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$553.34 ,"$1,963.65 ","$1,343.55 "
Outpatient Medical Services,CARDIAC,93312,TRANSESOPHAGEAL ECHO,360,"$1,422.00 ",$952.74 ,67% of billed charges for outpatient setting,$398.16 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$380.67 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$398.16 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,"$1,038.06 ",73% of billed charges for outpatient setting,"$1,279.80 ",90% of billed charges for outpatient setting,$395.90 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,"$1,137.60 ",80% of billed charges for outpatient setting,"$1,066.50 ",75% of billed charges for outpatient setting,$402.14 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$380.67 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$398.16 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$1,350.90 ",95% of billed charges for outpatient setting,$388.35 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$1,208.70 ",85% of billed charges for outpatient setting,$853.20 ,60% of billed charges for outpatient setting,$398.16 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$853.20 ,60% of billed charges for outpatient setting,$388.35 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$380.67 ,"$1,350.90 ",$924.30 
Outpatient Medical Services,CARDIAC,93015,CARDIOVASCULAR STRESS TEST,482,$940.00 ,$629.80 ,67% of billed charges for outpatient setting,$263.20 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$251.64 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$263.20 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$686.20 ,73% of billed charges for outpatient setting,$846.00 ,90% of billed charges for outpatient setting,$261.71 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$752.00 ,80% of billed charges for outpatient setting,$705.00 ,75% of billed charges for outpatient setting,$265.83 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$251.64 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$263.20 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$893.00 ,95% of billed charges for outpatient setting,$256.71 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$799.00 ,85% of billed charges for outpatient setting,$564.00 ,60% of billed charges for outpatient setting,$263.20 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$564.00 ,60% of billed charges for outpatient setting,$256.71 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$251.64 ,$893.00 ,$611.00 
Outpatient Medical Services,CARDIAC,93306,ECHOCARDIOGRAM  2 DIMENSIONAL MODE,483,"$1,236.00 ",$828.12 ,67% of billed charges for outpatient setting,$346.08 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$330.88 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$346.08 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$902.28 ,73% of billed charges for outpatient setting,"$1,112.40 ",90% of billed charges for outpatient setting,$344.12 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$988.80 ,80% of billed charges for outpatient setting,$927.00 ,75% of billed charges for outpatient setting,$349.54 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$330.88 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$346.08 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$1,174.20 ",95% of billed charges for outpatient setting,$337.55 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$1,050.60 ",85% of billed charges for outpatient setting,$741.60 ,60% of billed charges for outpatient setting,$346.08 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$741.60 ,60% of billed charges for outpatient setting,$337.55 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$330.88 ,"$1,174.20 ",$803.40 
Outpatient Medical Services,CARDIAC,93005,"EKG, 12 LEAD, TRACING ONLY CURRENT",730,$125.00 ,$83.75 ,67% of billed charges for outpatient setting,$35.00 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$33.46 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$35.00 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$91.25 ,73% of billed charges for outpatient setting,$112.50 ,90% of billed charges for outpatient setting,$34.80 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$100.00 ,80% of billed charges for outpatient setting,$93.75 ,75% of billed charges for outpatient setting,$35.35 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$33.46 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$35.00 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$118.75 ,95% of billed charges for outpatient setting,$34.14 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$106.25 ,85% of billed charges for outpatient setting,$75.00 ,60% of billed charges for outpatient setting,$35.00 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$75.00 ,60% of billed charges for outpatient setting,$34.14 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$33.46 ,$118.75 ,$81.25 
Outpatient Medical Services,CARDIAC,93000,EKG GLOBAL,985,$233.00 ,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,$25.09 ,100% GA Medicaid fee schedule for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,$26.09 ,104% GA Medicaid fee schedule for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,$25.09 ,100% GA Medicaid fee schedule for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,$25.59 ,102% GA Medicaid fee schedule for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,N/A,Not separately reimbursable for physician setting,$25.59 ,102% GA Medicaid fee schedule for physician setting,$25.09 ,$26.09 ,$151.45 
Outpatient Medical Services,CHEMO INJECTION,96416,CHEMO ADMIN IV INF PUMP INITIAL PROLONGE,335,"$1,243.66 ",$833.25 ,67% of billed charges for outpatient setting,$348.22 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$332.93 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$348.22 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$907.87 ,73% of billed charges for outpatient setting,"$1,119.29 ",90% of billed charges for outpatient setting,$346.25 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$994.93 ,80% of billed charges for outpatient setting,$932.75 ,75% of billed charges for outpatient setting,$351.71 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$332.93 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$348.22 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$1,181.48 ",95% of billed charges for outpatient setting,$339.64 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,"$1,057.11 ",85% of billed charges for outpatient setting,$746.20 ,60% of billed charges for outpatient setting,$348.22 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$746.20 ,60% of billed charges for outpatient setting,$339.64 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$332.93 ,"$1,181.48 ",$808.38 
Outpatient Medical Services,CHEMO INJECTION,96415,CHEMO ADMIN IV INFUSION ADDITIONAL HR,335,$255.26 ,$171.02 ,67% of billed charges for outpatient setting,$71.47 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$68.33 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$71.47 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$186.34 ,73% of billed charges for outpatient setting,$229.73 ,90% of billed charges for outpatient setting,$71.06 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$204.21 ,80% of billed charges for outpatient setting,$191.45 ,75% of billed charges for outpatient setting,$72.19 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$68.33 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$71.47 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$242.50 ,95% of billed charges for outpatient setting,$69.71 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$216.97 ,85% of billed charges for outpatient setting,$153.16 ,60% of billed charges for outpatient setting,$71.47 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$153.16 ,60% of billed charges for outpatient setting,$69.71 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$68.33 ,$242.50 ,$165.92 
Outpatient Medical Services,CHEMO INJECTION,96413,CHEMO ADMIN IV INFUSION INITIAL HOUR,335,"$1,131.94 ",$758.40 ,67% of billed charges for outpatient setting,$316.94 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$303.02 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$316.94 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$826.32 ,73% of billed charges for outpatient setting,"$1,018.75 ",90% of billed charges for outpatient setting,$315.14 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$905.55 ,80% of billed charges for outpatient setting,$848.96 ,75% of billed charges for outpatient setting,$320.11 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$303.02 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$316.94 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,"$1,075.34 ",95% of billed charges for outpatient setting,$309.13 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$962.15 ,85% of billed charges for outpatient setting,$679.16 ,60% of billed charges for outpatient setting,$316.94 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$679.16 ,60% of billed charges for outpatient setting,$309.13 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$303.02 ,"$1,075.34 ",$735.76 
Outpatient Medical Services,CHEMO INJECTION,96417,CHEMO ADMIN IV INFUSION SEQ 1 HR,335,$274.00 ,$183.58 ,67% of billed charges for outpatient setting,$76.72 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$73.35 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$76.72 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$200.02 ,73% of billed charges for outpatient setting,$246.60 ,90% of billed charges for outpatient setting,$76.28 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$219.20 ,80% of billed charges for outpatient setting,$205.50 ,75% of billed charges for outpatient setting,$77.49 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$73.35 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$76.72 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$260.30 ,95% of billed charges for outpatient setting,$74.83 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$232.90 ,85% of billed charges for outpatient setting,$164.40 ,60% of billed charges for outpatient setting,$76.72 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$164.40 ,60% of billed charges for outpatient setting,$74.83 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$73.35 ,$260.30 ,$178.10 
Outpatient Medical Services,CHEMO INJECTION,96411,CHEMO ADMIN IV PUSH EA ADDITIONAL,331,$514.80 ,$344.92 ,67% of billed charges for outpatient setting,$144.14 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$137.81 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$144.14 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$375.80 ,73% of billed charges for outpatient setting,$463.32 ,90% of billed charges for outpatient setting,$143.32 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$411.84 ,80% of billed charges for outpatient setting,$386.10 ,75% of billed charges for outpatient setting,$145.59 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$137.81 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$144.14 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$489.06 ,95% of billed charges for outpatient setting,$140.59 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$437.58 ,85% of billed charges for outpatient setting,$308.88 ,60% of billed charges for outpatient setting,$144.14 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$308.88 ,60% of billed charges for outpatient setting,$140.59 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$137.81 ,$489.06 ,$334.62 
Outpatient Medical Services,CHEMO INJECTION,96409,CHEMO ADMIN IV PUSH INTITIAL,331,$427.00 ,$286.09 ,67% of billed charges for outpatient setting,$119.56 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$114.31 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$119.56 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$311.71 ,73% of billed charges for outpatient setting,$384.30 ,90% of billed charges for outpatient setting,$118.88 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$341.60 ,80% of billed charges for outpatient setting,$320.25 ,75% of billed charges for outpatient setting,$120.76 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$114.31 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$119.56 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$405.65 ,95% of billed charges for outpatient setting,$116.61 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$362.95 ,85% of billed charges for outpatient setting,$256.20 ,60% of billed charges for outpatient setting,$119.56 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$256.20 ,60% of billed charges for outpatient setting,$116.61 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$114.31 ,$405.65 ,$277.55 
Outpatient Medical Services,CHEMO INJECTION,96401,CHEMO ADMIN SQ OR IM NON-HORMONAL ANTI-N,331,$198.72 ,$133.14 ,67% of billed charges for outpatient setting,$55.64 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$53.20 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$55.64 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$145.07 ,73% of billed charges for outpatient setting,$178.85 ,90% of billed charges for outpatient setting,$55.33 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$158.98 ,80% of billed charges for outpatient setting,$149.04 ,75% of billed charges for outpatient setting,$56.20 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$53.20 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$55.64 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$188.78 ,95% of billed charges for outpatient setting,$54.27 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$168.91 ,85% of billed charges for outpatient setting,$119.23 ,60% of billed charges for outpatient setting,$55.64 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$119.23 ,60% of billed charges for outpatient setting,$54.27 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$53.20 ,$188.78 ,$129.17 
Outpatient Medical Services,CHEMO INJECTION,96402,CHEMO ADMIN SQ/IM HORMONAL ANTI-NEOPLAST,331,$95.76 ,$64.16 ,67% of billed charges for outpatient setting,$26.81 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$25.63 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$26.81 ,28% of billed charges which is 100% of CMS Medicare rates for outpatient setting,$69.90 ,73% of billed charges for outpatient setting,$86.18 ,90% of billed charges for outpatient setting,$26.66 ,29.12% of total billed charges which is 104% GA Medicaid outpatient rate,$76.61 ,80% of billed charges for outpatient setting,$71.82 ,75% of billed charges for outpatient setting,$27.08 ,28.28% of billed charges which is 101% of CMS Medicare rates for outpatient setting,$25.63 ,26.77% of billed charges which is 100% of the GA Medicaid rate for outpatient setting,$26.81 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$90.97 ,95% of billed charges for outpatient setting,$26.15 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$81.40 ,85% of billed charges for outpatient setting,$57.46 ,60% of billed charges for outpatient setting,$26.81 ,28% of total billed charges which is 100% GA Medicaid outpatient rate,$57.46 ,60% of billed charges for outpatient setting,$26.15 ,28.56% of total billed charges which is 102% GA Medicaid outpatient rate,$25.63 ,$90.97 ,$62.24 
Outpatient Medical Services,BEHAVIORAL,90832,"Psychotherapy, 30 minute",900,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90834,"Psychotherapy, 45 minutes",900,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90837,"Psychotherapy, 60 minutes",900,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90846,"Family psychotherapy, not including patient, 50 minutes",900,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90847,"Family psychotherapy, including patient, 50 min",900,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,BEHAVIORAL,90853,Group psychotherapy,900,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,80055,Obstetric blood test panel,300,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,81000,Manual urinalysis test with examination using microscope,300,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,LAB,81002,Automated urinalysis test,300,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,42820,Removal of tonsils and adenoid glands patient younger than age 12,360,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,47562,Removal of gallbladder using an endoscope,360,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,49505,Repair of groin hernia patient age 5 or older,360,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,55700,Biopsy of prostate gland,360,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,55866,Surgical removal of prostate and surrounding lymph nodes using an endoscope,360,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,59400,"Routine obstetric care for vaginal delivery, including pre-and post-delivery care",720,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,59510,"Routine obstetric care for cesarean delivery, including pre-and post-delivery care",720,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,59610,Routine obstetric care for vaginal delivery after prior cesarean delivery including pre-and post-delivery care,720,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,62323,Injection of substance into spinal canal of lower back or sacrum using imaging guidanc,360,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,62322,Injection of substance into spinal canal of lower back or sacrum using imaging guidanc,360,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,64483,Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,360,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,OUTPATIENT SERVICES,66821,Removal of recurring cataract in lens capsule using laser,360,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A
Outpatient Medical Services,CARDIOLOGY,93452,Insertion of catheter into left heart for diagnosis,480,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A
Inpatient Medical Services,INPATIENT PROCEDURES,216,Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities,100,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A
Inpatient Medical Services,INPATIENT PROCEDURES,460,Spinal fusion except cervical without major comorbid conditions or complications,100,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A
Inpatient Medical Services,INPATIENT PROCEDURES,470,Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications,100,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A
Inpatient Medical Services,INPATIENT PROCEDURES,473,Cervical spinal fusion without comorbid conditions or major comorbid conditions or complications,100,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A
Inpatient Medical Services,INPATIENT PROCEDURES,743,Uterine and adnexa procedures for non-malignancy without comorbid conditions or major comorbid conditions or complications,100,SERVICE NOT OFFERED,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,Not separately reimbursable,N/A,N/A,N/A