Russell Medical Cares

Shoppable Service	Primary Service and Ancillary Services	Revenue Code	CPT/HCPCS Code	Cash Price	Service Location	Site Type	Aetna: Commercial	Aetna: Medicare Advantage	BCBSAL: Commercial	BCBSAL: Medicare Advantage	United Healthcare: Commercial	United Healthcare: Medicare Advantage	Viva Health: Commercial	Viva Health: Medicare Advantage	ChoiceCare: Medicare Advantage	Department of Labor: Workers Compensation	De-identified Minimum Negotiated Charge	De-identified Maximum Negotiated Charge
Removal of Breast Growth	Primary Procedure	360	19120	1129.92	Russell Medical Center	OP	1455.20	2673.64	821.03	2620.17	4853.33	2673.64	684.80	2673.64	2673.64	1609.28	399.59	4853.33
	Pharmacy	250		281.56	Russell Medical Center	OP	362.61	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	170.64	Included in Primary Procedure	Included in Primary Procedure	401.00	170.64	401.00
	Supplies	270		1160.18	Russell Medical Center	OP	1494.17	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	703.14	Included in Primary Procedure	Included in Primary Procedure	1652.38	703.14	1652.38
	Supplies	272		140.88	Russell Medical Center	OP	181.43	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	85.38	Included in Primary Procedure	Included in Primary Procedure	200.64	85.38	200.64
	Laboratory	300	36415	5.28	Russell Medical Center	OP	6.80	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	3.20	Included in Primary Procedure	Included in Primary Procedure	7.52	1.05	7.52
	Laboratory	300	80048	33.00	Russell Medical Center	OP	42.50	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	20.00	Included in Primary Procedure	Included in Primary Procedure	47.00	20.00	47.00
	Laboratory	300	85025	52.97	Russell Medical Center	OP	68.21	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	32.10	Included in Primary Procedure	Included in Primary Procedure	75.44	2.72	75.44
	Laboratory	300	C9803	38.28	Russell Medical Center	OP	49.30	Included in Primary Procedure	40.33	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	23.20	Included in Primary Procedure	Included in Primary Procedure	54.52	23.20	54.52
	Laboratory	300	U0003	85.80	Russell Medical Center	OP	110.50	Included in Primary Procedure	169.26	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	52.00	Included in Primary Procedure	Included in Primary Procedure	122.20	52.00	169.26
	Pathology	310	88304	72.27	Russell Medical Center	OP	93.08	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	43.80	Included in Primary Procedure	Included in Primary Procedure	102.93	43.80	102.93
	OR Services	360	27059	331.98	Russell Medical Center	OP	427.55	Included in Primary Procedure	3650.09	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	201.20	Included in Primary Procedure	Included in Primary Procedure	472.82	201.20	3650.09
	Pharmacy	636	J0690	16.50	Russell Medical Center	OP	21.25	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	10.00	Included in Primary Procedure	Included in Primary Procedure	23.50	10.00	23.50
	Pharmacy	636	J3010	11.22	Russell Medical Center	OP	14.45	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	6.80	Included in Primary Procedure	Included in Primary Procedure	15.98	6.80	15.98
	Pharmacy	636	J2405	39.93	Russell Medical Center	OP	51.43	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	24.20	Included in Primary Procedure	Included in Primary Procedure	56.87	0.09	56.87
	Pharmacy	636	J1100	12.87	Russell Medical Center	OP	16.58	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	7.80	Included in Primary Procedure	Included in Primary Procedure	18.33	0.12	18.33
	Recovery Room	710		377.52	Russell Medical Center	OP	486.20	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	228.80	Included in Primary Procedure	Included in Primary Procedure	537.68	228.80	537.68
	EKG	730	93005	80.52	Russell Medical Center	OP	103.70	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	48.80	Included in Primary Procedure	Included in Primary Procedure	114.68	48.80	114.68

Endoscopic Removal of Single Knee Cartilage	Primary Procedure		29881	1461.90	Russell Medical Center	OP	1882.75	2415.85	2932.10	2367.54	4385.39	2415.85	886.00	2415.85	2415.85	2082.10	886.00	4385.39
	Pharmacy	250		360.59	Russell Medical Center	OP	464.40	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	218.54	Included in Primary Procedure	Included in Primary Procedure	513.57	218.54	513.57
	Supplies	270		2448.73	Russell Medical Center	OP	3153.67	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	1484.08	Included in Primary Procedure	Included in Primary Procedure	3487.59	1484.08	3487.59
	Supplies	272		143.88	Russell Medical Center	OP	185.30	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	87.20	Included in Primary Procedure	Included in Primary Procedure	204.92	87.20	204.92
	Pathology	310	88304	36.14	Russell Medical Center	OP	46.54	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	21.90	Included in Primary Procedure	Included in Primary Procedure	51.47	21.90	51.47
	Physical Therp	420	97116	47.52	Russell Medical Center	OP	61.20	Included in Primary Procedure	286.49	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	28.80	Included in Primary Procedure	Included in Primary Procedure	67.68	28.80	286.49
	Pharmacy	636	J2250	11.22	Russell Medical Center	OP	14.45	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	6.80	Included in Primary Procedure	Included in Primary Procedure	15.98	6.80	15.98
	Pharmacy	636	J2175	22.44	Russell Medical Center	OP	28.90	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	13.60	Included in Primary Procedure	Included in Primary Procedure	31.96	4.72	31.96
	Pharmacy	636	J2405	79.86	Russell Medical Center	OP	102.85	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	48.40	Included in Primary Procedure	Included in Primary Procedure	113.74	0.09	113.74
	Pharmacy	636	J1100	12.87	Russell Medical Center	OP	16.58	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	7.80	Included in Primary Procedure	Included in Primary Procedure	18.33	0.12	18.33
	Pharmacy	636	J0690	16.50	Russell Medical Center	OP	21.25	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	10.00	Included in Primary Procedure	Included in Primary Procedure	23.50	10.00	23.50
	Pharmacy	636	J0702	63.36	Russell Medical Center	OP	81.60	Included in Primary Procedure	0.00	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	38.40	Included in Primary Procedure	Included in Primary Procedure	90.24	0.00	90.24
	Pharmacy	636	J3010	11.22	Russell Medical Center	OP	14.45	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	6.80	Included in Primary Procedure	Included in Primary Procedure	15.98	6.80	15.98
	Recovery Room	710		425.04	Russell Medical Center	OP	547.40	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	257.60	Included in Primary Procedure	Included in Primary Procedure	605.36	257.60	605.36

Endoscopic diagnostic examination of esophagus, stomach, and/or upper small bowel	Primary Procedure	360	43235	925.32	Russell Medical Center	OP	1191.70	693.59	1195.90	679.72	1259.04	693.59	560.80	693.59	693.59	1317.88	120.24	1317.88
	Pharmacy	250		28.71	Russell Medical Center	OP	36.98	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	17.40	Included in Primary Procedure	Included in Primary Procedure	40.89	17.40	40.89
	Supplies	270		255.02	Russell Medical Center	OP	328.44	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	154.56	Included in Primary Procedure	Included in Primary Procedure	363.22	154.56	363.22
	Supplies	272		55.01	Russell Medical Center	OP	70.85	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	33.34	Included in Primary Procedure	Included in Primary Procedure	78.35	33.34	78.35
	Laboratory	300	C9803	38.28	Russell Medical Center	OP	49.30	Included in Primary Procedure	40.33	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	23.20	Included in Primary Procedure	Included in Primary Procedure	54.52	23.20	54.52
	Laboratory	300	U0003	85.80	Russell Medical Center	OP	110.50	100.00	169.26	98.00	90.00	100.00	52.00	100.00	100.00	122.20	52.00	169.26
	Recovery Room	710		23.76	Russell Medical Center	OP	30.60	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	14.40	Included in Primary Procedure	Included in Primary Procedure	33.84	14.40	33.84

Endoscopic biopsy of the esophagus, stomach, and/or upper small bowel	Primary Procedure	360	43239	279.84	Russell Medical Center	OP	360.40	693.59	597.95	679.72	1259.04	693.59	169.60	693.59	693.59	398.56	135.75	1259.04
	Pharmacy	250		57.42	Russell Medical Center	OP	73.95	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	34.80	Included in Primary Procedure	Included in Primary Procedure	81.78	34.80	81.78
	Supplies	270		247.73	Russell Medical Center	OP	319.05	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	150.14	Included in Primary Procedure	Included in Primary Procedure	352.83	150.14	352.83
	Supplies	272	C1773	131.90	Russell Medical Center	OP	169.87	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	79.94	Included in Primary Procedure	Included in Primary Procedure	187.86	79.94	187.86
	Pathology	310	88305	84.48	Russell Medical Center	OP	108.80	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	51.20	Included in Primary Procedure	Included in Primary Procedure	120.32	51.20	120.32
	Pharmacy	636	J0290	11.22	Russell Medical Center	OP	14.45	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	6.80	Included in Primary Procedure	Included in Primary Procedure	15.98	6.80	15.98
	Pharmacy	637	A9270	5.28	Russell Medical Center	OP	6.80	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	3.20	Included in Primary Procedure	Included in Primary Procedure	7.52	3.20	7.52
	Recovery Room	710		23.76	Russell Medical Center	OP	30.60	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	14.40	Included in Primary Procedure	Included in Primary Procedure	33.84	14.40	33.84
	Gastrointestinal Services	750	45385	1015.74	Russell Medical Center	OP	1308.15	443.12	615.26	434.26	804.38	443.12	615.60	443.12	443.12	1446.66	250.71	1446.66

Endoscopic diagnostic examination of large bowel	Primary Procedure	750	45378	677.38	Russell Medical Center	OP	872.38	674.14	499.51	660.66	1223.73	674.14	410.53	674.14	674.14	964.75	182.01	1223.73
	Pharmacy	250		77.55	Russell Medical Center	OP	99.88	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	47.00	Included in Primary Procedure	Included in Primary Procedure	110.45	47.00	110.45
	Supplies	270		296.21	Russell Medical Center	OP	381.48	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	179.52	Included in Primary Procedure	Included in Primary Procedure	421.87	179.52	421.87
	Supplies	272		140.38	Russell Medical Center	OP	180.80	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	85.08	Included in Primary Procedure	Included in Primary Procedure	199.94	85.08	199.94
	Laboratory	300	82607	40.10	Russell Medical Center	OP	51.64	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	24.30	Included in Primary Procedure	Included in Primary Procedure	57.11	24.30	57.11
	Laboratory	300	82728	47.85	Russell Medical Center	OP	61.63	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	29.00	Included in Primary Procedure	Included in Primary Procedure	68.15	29.00	68.15
	Laboratory	300	82746	31.52	Russell Medical Center	OP	40.59	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	19.10	Included in Primary Procedure	Included in Primary Procedure	44.89	19.10	44.89
	Laboratory	300	83540	16.83	Russell Medical Center	OP	21.68	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	10.20	Included in Primary Procedure	Included in Primary Procedure	23.97	10.20	23.97
	Laboratory	300	84466	35.15	Russell Medical Center	OP	45.26	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	21.30	Included in Primary Procedure	Included in Primary Procedure	50.06	21.30	50.06
	Laboratory	300	85025	52.97	Russell Medical Center	OP	68.21	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	32.10	Included in Primary Procedure	Included in Primary Procedure	75.44	2.72	75.44
	Recovery Room	710		23.76	Russell Medical Center	OP	30.60	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	14.40	Included in Primary Procedure	Included in Primary Procedure	33.84	14.40	33.84
	Gastrointestinal Services	750	43249	677.38	Russell Medical Center	OP	872.38	Included in Primary Procedure	597.95	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	410.53	Included in Primary Procedure	Included in Primary Procedure	964.75	150.47	964.75
	Gastrointestinal Services	750	43239	677.38	Russell Medical Center	OP	872.39	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	410.54	Included in Primary Procedure	Included in Primary Procedure	964.76	135.75	964.76

Endoscopic biopsy of Large Bowel	Primary Procedure	360	45380	1295.58	Russell Medical Center	OP	1668.55	886.24	999.02	868.52	1608.75	886.24	785.20	886.24	886.24	1845.22	197.33	1845.22
	Pharmacy	250		33.99	Russell Medical Center	OP	43.78	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	20.60	Included in Primary Procedure	Included in Primary Procedure	48.41	20.60	48.41
	Supplies	270		1181.83	Russell Medical Center	OP	1522.05	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	716.26	Included in Primary Procedure	Included in Primary Procedure	1683.21	716.26	1683.21
	Supplies	272		131.90	Russell Medical Center	OP	169.87	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	79.94	Included in Primary Procedure	Included in Primary Procedure	187.86	79.94	187.86
	Pathology	310	88305	84.48	Russell Medical Center	OP	108.80	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	51.20	Included in Primary Procedure	Included in Primary Procedure	120.32	51.20	120.32
	Recovery Room	710		23.76	Russell Medical Center	OP	30.60	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	14.40	Included in Primary Procedure	Included in Primary Procedure	33.84	14.40	33.84

Endoscopic removal of polyps or growths of large bowel	Primary Procedure	750	45385	1015.74	Russell Medical Center	OP	1308.15	886.24	615.26	868.52	1608.75	886.24	615.60	886.24	886.24	1446.66	250.71	1608.75
	Pharmacy	250		57.42	Russell Medical Center	OP	73.95	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	34.80	Included in Primary Procedure	Included in Primary Procedure	81.78	34.80	81.78
	Supplies	270		247.73	Russell Medical Center	OP	319.05	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	150.14	Included in Primary Procedure	Included in Primary Procedure	352.83	150.14	352.83
	Supplies	272	C1773	131.90	Russell Medical Center	OP	169.87	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	79.94	Included in Primary Procedure	Included in Primary Procedure	187.86	79.94	187.86
	Pathology	310	88305	84.48	Russell Medical Center	OP	108.80	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	51.20	Included in Primary Procedure	Included in Primary Procedure	120.32	51.20	120.32
	Pharmacy	636	J0290	11.22	Russell Medical Center	OP	14.45	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	6.80	Included in Primary Procedure	Included in Primary Procedure	15.98	6.80	15.98
	Pharmacy	637	A9270	5.28	Russell Medical Center	OP	6.80	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	3.20	Included in Primary Procedure	Included in Primary Procedure	7.52	3.20	7.52
	Recovery Room	710		23.76	Russell Medical Center	OP	30.60	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	14.40	Included in Primary Procedure	Included in Primary Procedure	33.84	14.40	33.84
	Gastrointestinal Services	750	43239	279.84	Russell Medical Center	OP	360.40	346.80	597.95	339.86	629.52	346.80	169.60	346.80	346.80	398.56	135.75	629.52

Endoscopic Removal of Gallbladder	Primary Procedure	360	47562	2453.88	Russell Medical Center	OP	3160.30	4265.85	5376.54	4180.53	7743.58	4265.85	1487.20	4265.85	4265.85	3494.92	540.21	7743.58
	Pharmacy	250		479.82	Russell Medical Center	OP	617.95	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	290.80	Included in Primary Procedure	Included in Primary Procedure	683.38	290.80	683.38
	Supplies	270		546.84	Russell Medical Center	OP	704.27	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	331.42	Included in Primary Procedure	Included in Primary Procedure	778.84	331.42	778.84
	Supplies	272		2666.00	Russell Medical Center	OP	3433.49	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	1615.76	Included in Primary Procedure	Included in Primary Procedure	3797.04	1615.76	3797.04
	Pathology	310	88304	36.14	Russell Medical Center	OP	46.54	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	21.90	Included in Primary Procedure	Included in Primary Procedure	51.47	21.90	51.47
	Anesthesia	370		109.07	Russell Medical Center	OP	140.46	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	66.10	Included in Primary Procedure	Included in Primary Procedure	155.34	66.10	155.34
	Pharmacy	636	J1885	39.93	Russell Medical Center	OP	51.43	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	24.20	Included in Primary Procedure	Included in Primary Procedure	56.87	24.20	56.87
	Pharmacy	636	J0330	11.22	Russell Medical Center	OP	14.45	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	6.80	Included in Primary Procedure	Included in Primary Procedure	15.98	6.80	15.98
	Pharmacy	636	J2405	39.93	Russell Medical Center	OP	51.43	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	24.20	Included in Primary Procedure	Included in Primary Procedure	56.87	0.09	56.87
	Pharmacy	636	J1100	12.87	Russell Medical Center	OP	16.58	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	7.80	Included in Primary Procedure	Included in Primary Procedure	18.33	0.12	18.33
	Pharmacy	636	J3010	11.22	Russell Medical Center	OP	14.45	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	6.80	Included in Primary Procedure	Included in Primary Procedure	15.98	6.80	15.98
	Pharmacy	637	A9270	2.15	Russell Medical Center	OP	2.76	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	1.30	Included in Primary Procedure	Included in Primary Procedure	3.06	1.30	3.06
	Pharmacy	637	A9270	106.92	Russell Medical Center	OP	137.70	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	64.80	Included in Primary Procedure	Included in Primary Procedure	152.28	64.80	152.28
	Recovery Room	710		646.80	Russell Medical Center	OP	833.00	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	392.00	Included in Primary Procedure	Included in Primary Procedure	921.20	392.00	921.20
Injection of substance into spinal canal of lower back or sacrum using imaging guidance	Primary Procedure		62323	778.80	Russell Medical Center	OP	1003.00	Included in Primary Procedure	1146.83	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	472.00	Included in Primary Procedure	Included in Primary Procedure	1109.20	472.00	1146.83

Biopsy of prostate gland	Primary Procedure		55700	1129.92	Russell Medical Center	OP	1455.20	1563.43	1792.83	1532.16	2838.01	1563.43	684.80	1563.43	1563.43	1609.28	129.13	2838.01
	Pharmacy	250		225.06	Russell Medical Center	OP	289.85	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	136.40	Included in Primary Procedure	Included in Primary Procedure	320.54	136.40	320.54
	Supplies	270		311.52	Russell Medical Center	OP	401.20	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	188.80	Included in Primary Procedure	Included in Primary Procedure	443.68	188.80	443.68
	Supplies	272		97.65	Russell Medical Center	OP	125.76	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	59.18	Included in Primary Procedure	Included in Primary Procedure	139.07	59.18	139.07
	Laboratory	300	U0003	85.80	Russell Medical Center	OP	110.50	Included in Primary Procedure	169.26	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	52.00	Included in Primary Procedure	Included in Primary Procedure	122.20	52.00	169.26
			C9803	38.28		OP	49.30	Included in Primary Procedure	40.33	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	23.20	Included in Primary Procedure	Included in Primary Procedure	54.52	23.20	54.52
			80048	33.00		OP	42.50	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	20.00	Included in Primary Procedure	Included in Primary Procedure	47.00	20.00	47.00
			36415	5.28		OP	6.80	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	3.20	Included in Primary Procedure	Included in Primary Procedure	7.52	1.05	7.52
	Pathology	310	88305	1182.72	Russell Medical Center	OP	1523.20	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	716.80	Included in Primary Procedure	Included in Primary Procedure	1684.48	716.80	1684.48
	Ultrasound	402	76942 XU	251.46	Russell Medical Center	OP	323.85	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	152.40	Included in Primary Procedure	Included in Primary Procedure	358.14	152.40	358.14
			76872	197.51		OP	254.36	Included in Primary Procedure	218.71	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	119.70	Included in Primary Procedure	Included in Primary Procedure	281.30	97.17	281.30
	Pharmacy	636	J1580	23.76	Russell Medical Center	OP	30.60	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	14.40	Included in Primary Procedure	Included in Primary Procedure	33.84	1.51	33.84
	Pharmacy	636	J3010	11.22	Russell Medical Center	OP	14.45	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	6.80	Included in Primary Procedure	Included in Primary Procedure	15.98	6.80	15.98
	Pharmacy	636	J2405	39.93	Russell Medical Center	OP	51.43	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	24.20	Included in Primary Procedure	Included in Primary Procedure	56.87	0.09	56.87
	Pharmacy	636	J1100	12.87	Russell Medical Center	OP	16.58	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	7.80	Included in Primary Procedure	Included in Primary Procedure	18.33	0.12	18.33
	Pharmacy	636	A9270 GY	2.15	Russell Medical Center	OP	2.76	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	1.30	Included in Primary Procedure	Included in Primary Procedure	3.06	1.30	3.06
	Recovery Room	710		353.76	Russell Medical Center	OP	455.60	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	214.40	Included in Primary Procedure	Included in Primary Procedure	503.84	214.40	503.84
	EKG	730	93005	80.52	Russell Medical Center	OP	103.70	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	48.80	Included in Primary Procedure	Included in Primary Procedure	114.68	48.80	114.68

Spinal fusion except cervical without major comorbid conditions or complications (MCC)	MS-DRG		460	0.00	Russell Medical Center	IP	0.00	21747.31	$3,519 per diem	21312.36	34322.49	21747.31	$2,300 per diem	21747.31	21747.31	$3,650 per diem	0.00	34322.49
	Room & Board	120		462.00	Russell Medical Center	IP	595.00	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	595.00	595.00
	Pharmacy	250		1020.76	Russell Medical Center	IP	1314.61	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	1314.61	1314.61
	Supplies	270		5750.45	Russell Medical Center	IP	7405.88	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	7405.88	7405.88
	Supplies	272		1588.36	Russell Medical Center	IP	2045.61	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	2045.61	2045.61
	Implants	278		338.58	Russell Medical Center	IP	436.05	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	436.05	436.05
	Laboratory	300		351.29	Russell Medical Center	IP	452.41	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	452.41	452.41
	Radiology	320		127.84	Russell Medical Center	IP	164.65	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	164.65	164.65
	OR Services	360		2457.84	Russell Medical Center	IP	3165.40	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	3165.40	3165.40
	Physical Therapy	420		120.12	Russell Medical Center	IP	154.70	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	154.70	154.70
	Physical Therapy	424		130.68	Russell Medical Center	IP	168.30	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	168.30	168.30
	Recovery Room	710		425.04	Russell Medical Center	IP	547.40	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	547.40	547.40
	EKG	730		80.52	Russell Medical Center	IP	103.70	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	103.70	103.70

Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications (MCC).	MS-DRG		470	0.00	Russell Medical Center	IP	0.00	10808.86	$3,519 per diem	10592.68	17058.98	10808.86	$2,300 per diem	10808.86	10808.86	$3,650 per diem	0.00	17058.98
	Room & Board	120		1386.00	Russell Medical Center	IP	1785.00	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	1785.00	1785.00
	Pharmacy	250		1173.38	Russell Medical Center	IP	1511.17	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	1511.17	1511.17
	Supplies	270		2567.04	Russell Medical Center	IP	3306.03	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	3306.03	3306.03
	Supplies	272		335.18	Russell Medical Center	IP	431.67	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	431.67	431.67
	Implants	278		5240.40	Russell Medical Center	IP	6749.00	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	6749.00	6749.00
	Laboratory	300		458.21	Russell Medical Center	IP	590.11	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	590.11	590.11
	Pathology	310		42.08	Russell Medical Center	IP	54.19	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	54.19	54.19
	Radiology	320		263.67	Russell Medical Center	IP	339.58	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	339.58	339.58
	OR Services	360		2125.86	Russell Medical Center	IP	2737.85	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	2737.85	2737.85
	Anesthesia	370		109.07	Russell Medical Center	IP	140.46	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	140.46	140.46
	Blood Admin	390		29.04	Russell Medical Center	IP	37.40	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	37.40	37.40
	Physical Therapy	420		425.70	Russell Medical Center	IP	548.25	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	548.25	548.25
	Physical Therapy	424		188.76	Russell Medical Center	IP	243.10	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	243.10	243.10
	Recovery Room	710		330.00	Russell Medical Center	IP	425.00	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	425.00	425.00

Uterine and adnexa procedures for non-malignancy without comorbid conditions (CC) or major comorbid conditions or complications (MCC)	MS-DRG		743	0.00	Russell Medical Center	IP	0.00	6306.63	$3,519 per diem	6180.50	9953.38	6306.63	$2,300 per diem	6306.63	6306.63	$3,650 per diem	0.00	9953.38
	Room & Board	120		462.00	Russell Medical Center	IP	595.00	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	595.00	595.00
	Pharmacy	250		1082.20	Russell Medical Center	IP	1393.75	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	1393.75	1393.75
	Supplies	270		2952.02	Russell Medical Center	IP	3801.84	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	3801.84	3801.84
	Supplies	272		2761.80	Russell Medical Center	IP	3556.87	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	3556.87	3556.87
	Laboratory	300		301.29	Russell Medical Center	IP	388.03	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	388.03	388.03
	Pathology	310		168.63	Russell Medical Center	IP	217.18	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	217.18	217.18
	OR Services	360		2789.82	Russell Medical Center	IP	3592.95	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	3592.95	3592.95
	Blood Admin	390		29.04	Russell Medical Center	IP	37.40	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	37.40	37.40
	Recovery Room	710		330.00	Russell Medical Center	IP	425.00	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	425.00	425.00

Removal of cataract with insertion of lens	Primary Procedure		66984	836.88	Russell Medical Center	OP	1077.80	1784.33	2273.86	1748.65	3239.01	1784.33	507.20	1784.33	1784.33	1191.92	507.20	3239.01
	Pharmacy	250		282.48	Russell Medical Center	OP	363.80	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	171.20	Included in Primary Procedure	Included in Primary Procedure	402.32	171.20	402.32
	Supplies	270		903.47	Russell Medical Center	OP	1163.57	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	547.56	Included in Primary Procedure	Included in Primary Procedure	1286.77	547.56	1286.77
	Supplies	272		14.39	Russell Medical Center	OP	18.53	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	8.72	Included in Primary Procedure	Included in Primary Procedure	20.49	8.72	20.49
	Intraocular Lens	276	C1780	683.76	Russell Medical Center	OP	880.60	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	414.40	Included in Primary Procedure	Included in Primary Procedure	973.84	414.40	973.84
	Pharmacy	636	J2405	11.22	Russell Medical Center	OP	14.45	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	6.80	Included in Primary Procedure	Included in Primary Procedure	15.98	0.09	15.98
	Pharmacy	636	J3010	11.22	Russell Medical Center	OP	14.45	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	6.80	Included in Primary Procedure	Included in Primary Procedure	15.98	6.80	15.98
	Recovery Room	710		39.60	Russell Medical Center	OP	51.00	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	24.00	Included in Primary Procedure	Included in Primary Procedure	56.40	24.00	56.40

Shaving of shoulder bone using an endoscope	Primary Procedure	360	29826	365.48	Russell Medical Center	OP	470.69	Included in Primary Procedure	1466.05	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	221.50	Included in Primary Procedure	Included in Primary Procedure	520.53	221.50	1466.05
	Pharmacy	250		463.39	Russell Medical Center	OP	596.79	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	280.84	Included in Primary Procedure	Included in Primary Procedure	659.97	280.84	659.97
	Supplies	270		2878.49	Russell Medical Center	OP	3707.15	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	1744.54	Included in Primary Procedure	Included in Primary Procedure	4099.67	1744.54	4099.67
	Supplies	272		1009.73	Russell Medical Center	OP	1300.42	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	611.96	Included in Primary Procedure	Included in Primary Procedure	1438.11	611.96	1438.11
	Implants	278	C1713	970.20	Russell Medical Center	OP	1249.50	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	588.00	Included in Primary Procedure	Included in Primary Procedure	1381.80	588.00	1381.80
	Laboratory	300	36415	5.28	Russell Medical Center	OP	6.80	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	3.20	Included in Primary Procedure	Included in Primary Procedure	7.52	1.05	7.52
	Laboratory	300	80048	33.00	Russell Medical Center	OP	42.50	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	20.00	Included in Primary Procedure	Included in Primary Procedure	47.00	20.00	47.00
	Laboratory	300	C9803	38.28	Russell Medical Center	OP	49.30	Included in Primary Procedure	40.33	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	23.20	Included in Primary Procedure	Included in Primary Procedure	54.52	23.20	54.52
	Laboratory	300	U0003	85.80	Russell Medical Center	OP	110.50	Included in Primary Procedure	169.26	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	52.00	Included in Primary Procedure	Included in Primary Procedure	122.20	52.00	169.26
	Laboratory	300	82948	11.88	Russell Medical Center	OP	15.30	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	7.20	Included in Primary Procedure	Included in Primary Procedure	16.92	2.27	16.92
	Laboratory	300	85027	23.10	Russell Medical Center	OP	29.75	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	14.00	Included in Primary Procedure	Included in Primary Procedure	32.90	2.26	32.90
	Pathology	310	88304	36.14	Russell Medical Center	OP	46.54	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	21.90	Included in Primary Procedure	Included in Primary Procedure	51.47	21.90	51.47
	OR Services	360	29827	352.28	Russell Medical Center	OP	453.69	5279.19	3471.47	5173.61	9583.05	5279.19	213.50	5279.19	5279.19	501.73	213.50	9583.05
	OR Services	360	29828	352.28	Russell Medical Center	OP	453.69	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	213.50	Included in Primary Procedure	Included in Primary Procedure	501.73	213.50	501.73
	OR Services	360	29823	352.28	Russell Medical Center	OP	453.69	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	213.50	Included in Primary Procedure	Included in Primary Procedure	501.73	213.50	501.73
	Pharmacy	636	J2405	39.93	Russell Medical Center	OP	51.43	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	24.20	Included in Primary Procedure	Included in Primary Procedure	56.87	0.09	56.87
	Pharmacy	636	J1100	12.87	Russell Medical Center	OP	16.58	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	7.80	Included in Primary Procedure	Included in Primary Procedure	18.33	0.12	18.33
	Pharmacy	636	J0690	16.50	Russell Medical Center	OP	21.25	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	10.00	Included in Primary Procedure	Included in Primary Procedure	23.50	10.00	23.50
	Pharmacy	636	J0702	63.36	Russell Medical Center	OP	81.60	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	38.40	Included in Primary Procedure	Included in Primary Procedure	90.24	38.40	90.24
	Pharmacy	636	J3010	11.22	Russell Medical Center	OP	14.45	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	6.80	Included in Primary Procedure	Included in Primary Procedure	15.98	6.80	15.98
	Pharmacy	636	J0330	11.22	Russell Medical Center	OP	14.45	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	6.80	Included in Primary Procedure	Included in Primary Procedure	15.98	6.80	15.98
	Recovery Room	710		353.76	Russell Medical Center	OP	455.60	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	214.40	Included in Primary Procedure	Included in Primary Procedure	503.84	214.40	503.84
	EKG	730	93005	80.52	Russell Medical Center	OP	103.70	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	Included in Primary Procedure	48.80	Included in Primary Procedure	Included in Primary Procedure	114.68	48.80	114.68
Removal of tonsils and adenoid glands patient younger than age 12	Primary Procedure	360	42820	3340.26	Russell Medical Center	OP	4301.85	4280.69	2563.16	4195.08	7770.52	4280.69	2024.40	4280.69	4280.69	4757.34	2024.40	7770.52

Patient office consultation, typically 40 min			99243	108.90	Russell Medical Center	OP	140.25	Not Applicable	0.00	Not Applicable	Not Applicable	Not Applicable	99.00	Not Applicable	Not Applicable	155.10	0.00	155.10

Patient office consultation, typically 60 min			99244	140.58	Russell Medical Center	OP	181.05	Not Applicable	0.00	Not Applicable	Not Applicable	Not Applicable	127.80	Not Applicable	Not Applicable	200.22	0.00	200.22

Initial new patient preventive medicine evaluation (18-39 years)			99385	71.28	Russell Medical Center	OP	91.80	Not Applicable	0.00	Not Applicable	Not Applicable	Not Applicable	64.80	Not Applicable	Not Applicable	101.52	0.00	107.08

Initial new patient preventive medicine evaluation (40-64 years)			99386	75.24	Russell Medical Center	OP	96.90	Not Applicable	0.00	Not Applicable	Not Applicable	Not Applicable	68.40	Not Applicable	Not Applicable	107.16	0.00	124.21

CT scan, head or brain, without contrast			70450	413.16	Russell Medical Center	OP	532.10	98.91	423.54	96.93	179.56	98.91	375.60	98.91	98.91	588.44	96.93	588.44

MRI scan of brain before and after contrast			70553	4679.40	Russell Medical Center	OP	6026.50	336.99	601.85	330.25	611.73	336.99	4254.00	336.99	336.99	6664.60	330.25	6664.60

X-Ray, lower back, minimum four views			72110	135.96	Russell Medical Center	OP	175.10	98.91	77.69	96.93	179.56	98.91	123.60	98.91	98.91	193.64	31.08	193.64

MRI scan of lower spinal canal			72148	1353.66	Russell Medical Center	OP	1743.35	205.66	344.84	201.55	373.33	205.66	1230.60	205.66	205.66	1927.94	201.55	1927.94

CT scan, pelvis, with contrast			72193	570.90	Russell Medical Center	OP	735.25	160.81	423.54	157.60	291.92	160.81	519.00	160.81	160.81	813.10	157.60	813.10

MRI scan of leg joint			73721	1353.66	Russell Medical Center	OP	1743.35	205.66	344.84	201.55	373.33	205.66	1230.60	205.66	205.66	1927.94	201.55	1927.94

CT scan of abdomen and pelvis with contrast			74177	864.60	Russell Medical Center	OP	1113.50	336.99	423.54	330.25	611.73	336.99	786.00	336.99	336.99	1231.40	330.25	1231.40

Ultrasound of abdomen			76700	224.40	Russell Medical Center	OP	289.00	98.91	284.15	96.93	179.56	98.91	204.00	98.91	98.91	319.60	79.62	319.60

Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus			76805	273.24	Russell Medical Center	OP	351.90	98.91	138.45	96.93	179.56	98.91	248.40	98.91	98.91	389.16	90.84	389.16

Ultrasound pelvis through vagina			76830	198.33	Russell Medical Center	OP	255.43	98.91	218.71	96.93	179.56	98.91	180.30	98.91	98.91	282.47	79.42	282.47

Mammography of one breast			77065	121.18	Russell Medical Center	OP	156.06	83.99	92.27	82.31	83.99	83.99	110.16	83.99	83.99	172.58	82.31	172.58

Mammography of both breasts			77066	285.12	Russell Medical Center	OP	367.20	107.09	92.27	104.95	107.09	107.09	259.20	107.09	107.09	406.08	92.27	406.08

Mammography, screening, bilateral			77067	157.08	Russell Medical Center	OP	202.30	88.81	92.27	87.03	88.81	88.81	142.80	88.81	88.81	223.72	87.03	223.72

Basic metabolic panel			80048	30.20	Russell Medical Center	OP	38.89	8.46	13.65	8.29	0.00	8.46	27.45	8.46	8.46	43.01	0.00	43.01

Blood test, comprehensive group of blood chemicals			80053	62.37	Russell Medical Center	OP	80.33	10.56	13.65	10.35	0.00	10.56	56.70	10.56	10.56	88.83	0.00	88.83

Blood test, lipids (cholesterol and triglycerides)			80061	15.18	Russell Medical Center	OP	19.55	13.39	13.65	13.12	12.05	13.39	13.80	13.39	13.39	21.62	4.69	21.62

Kidney function panel test			80069	27.72	Russell Medical Center	OP	35.70	8.68	13.65	8.51	0.00	8.68	25.20	8.68	8.68	39.48	0.00	39.48

Liver function blood test panel			80076	41.25	Russell Medical Center	OP	53.13	8.17	13.65	8.01	0.00	8.17	37.50	8.17	8.17	58.75	0.00	58.75

Manual urinalysis test with examination using microscope			81001	35.64	Russell Medical Center	OP	45.90	3.17	4.45	3.11	0.00	3.17	32.40	3.17	3.17	50.76	0.00	50.76

Automated urinalysis test			81003	28.38	Russell Medical Center	OP	36.55	2.25	4.45	2.21	0.00	2.25	25.80	2.25	2.25	40.42	0.00	40.42

PSA (prostate specific antigen)			84154	48.51	Russell Medical Center	OP	62.48	18.39	14.74	18.02	0.00	18.39	44.10	18.39	18.39	69.09	0.00	69.09

Blood test, thyroid stimulating hormone (TSH)			84443	45.87	Russell Medical Center	OP	59.08	16.80	20.36	16.46	0.00	16.80	41.70	16.80	16.80	65.33	0.00	65.33

Complete blood cell count, with differential white blood cells, automated			85025	52.97	Russell Medical Center	OP	68.21	7.77	8.81	7.61	0.00	7.77	48.15	7.77	7.77	75.44	0.00	75.44

Complete blood count, automated			85027	23.10	Russell Medical Center	OP	29.75	6.47	8.81	6.34	0.00	6.47	21.00	6.47	6.47	32.90	0.00	32.90

Blood test, clotting time			85610	26.90	Russell Medical Center	OP	34.64	4.29	5.62	4.20	0.00	4.29	24.45	4.29	4.29	38.31	0.00	38.31

Coagulation assessment blood test			85730	26.24	Russell Medical Center	OP	33.79	6.01	5.62	5.89	0.00	6.01	23.85	6.01	6.01	37.37	0.00	37.37

Insertion of catheter into left heart for diagnosis			93452	5398.80	Russell Medical Center	OP	6953.00	2515.14	3377.01	2464.84	4565.60	2515.14	4908.00	2515.14	2515.14	7689.20	2464.84	7689.20

Sleep Study			95810	1416.36	Russell Medical Center	OP	1824.10	802.17	1070.39	786.12	1456.13	802.17	1287.60	802.17	802.17	2017.24	475.58	2017.24

Physical therapy, therapeutic exercise			97110	43.76	Russell Medical Center	OP	56.36	29.58	286.49	28.99	29.58	29.58	39.78	29.58	29.58	62.32	28.99	286.49

New patient office or other outpatient visit, typically 30 min			99203	104.94	Russell Medical Center	OP	135.15	Not Applicable	0.00	Not Applicable	Not Applicable	Not Applicable	95.40	Not Applicable	Not Applicable	149.46	0.00	149.46

New patient office of other outpatient visit, typically 45 min			99204	101.64	Russell Medical Center	OP	130.90	Not Applicable	0.00	Not Applicable	Not Applicable	Not Applicable	92.40	Not Applicable	Not Applicable	144.76	0.00	144.76

New patient office of other outpatient visit, typically 60 min			99205	152.46	Russell Medical Center	OP	196.35	Not Applicable	0.00	Not Applicable	Not Applicable	Not Applicable	138.60	Not Applicable	Not Applicable	217.14	0.00	217.14

Admin hepatitis b vaccine			G0010	62.19	Russell Medical Center	OP	80.10	33.63	57.02	32.96	61.05	33.63	56.54	33.63	33.63	88.58	11.36	88.58

Admin pneumococcal vaccine			G0009	44.88	Russell Medical Center	OP	57.80	33.63	57.02	32.96	61.05	33.63	40.80	33.63	33.63	63.92	11.36	63.92

Admin influenza virus vac			G0008	85.80	Russell Medical Center	OP	110.50	33.63	57.02	32.96	61.05	33.63	78.00	33.63	33.63	122.20	11.36	122.20

OUTPATIENT CONSULT LEVEL 5			99245	174.90	Russell Medical Center	OP	225.25	Not Applicable	0.00	Not Applicable	Not Applicable	Not Applicable	159.00	Not Applicable	Not Applicable	249.10	0.00	249.10

SUBSEQUENT HOSP VISIT LEVEL 1			99231	56.10	Russell Medical Center	OP	72.25	Not Applicable	0.00	Not Applicable	Not Applicable	Not Applicable	51.00	Not Applicable	Not Applicable	79.90	0.00	79.90

SUBSEQUENT HOSP VISIT LEVEL 2			99232	100.98	Russell Medical Center	OP	130.05	Not Applicable	0.00	Not Applicable	Not Applicable	Not Applicable	91.80	Not Applicable	Not Applicable	143.82	0.00	143.82

OFFICE OUTPATIENT VISIT 25 MINUTES			99214	57.42	Russell Medical Center	OP	73.95	Not Applicable	0.00	Not Applicable	Not Applicable	Not Applicable	52.20	Not Applicable	Not Applicable	81.78	0.00	96.00

OFFICE OUTPATIENT VISIT 15 MINUTES			99213	45.54	Russell Medical Center	OP	58.65	Not Applicable	0.00	Not Applicable	Not Applicable	Not Applicable	41.40	Not Applicable	Not Applicable	64.86	0.00	64.86

OFFICE OUTPATIENT VISIT 10 MINUTES			99212	36.96	Russell Medical Center	OP	47.60	Not Applicable	0.00	Not Applicable	Not Applicable	Not Applicable	33.60	Not Applicable	Not Applicable	52.64	0.00	52.64

OFFICE OUTPATIENT VISIT 5 MINUTES			99211	27.72	Russell Medical Center	OP	35.70	Not Applicable	0.00	Not Applicable	Not Applicable	Not Applicable	25.20	Not Applicable	Not Applicable	39.48	0.00	39.48

OFFICE OUTPATIENT NEW 20 MINUTES			99202	50.82	Russell Medical Center	OP	65.45	Not Applicable	0.00	Not Applicable	Not Applicable	Not Applicable	46.20	Not Applicable	Not Applicable	72.38	0.00	72.38

OFFICE OUTPATIENT NEW 10 MINUTES			99201	149.16	Russell Medical Center	OP	192.10	Not Applicable	0.00	Not Applicable	Not Applicable	Not Applicable	135.60	Not Applicable	Not Applicable	212.44	0.00	212.44

STRESS ECHO			93017	336.60	Russell Medical Center	OP	433.50	223.37	515.03	218.90	405.47	223.37	306.00	223.37	223.37	479.40	218.90	515.03

EKG WITH MAGNET TRACING ONLY			93005	80.52	Russell Medical Center	OP	103.70	48.55	36.66	47.58	88.13	48.55	73.20	48.55	48.55	114.68	36.66	114.68

ECHO DOPPLER			93320	132.00	Russell Medical Center	OP	170.00	0.00	673.61	0.00	0.00	0.00	120.00	0.00	0.00	188.00	0.00	673.61

ECHO COLOR DOPPLER FLOW			93325	235.47	Russell Medical Center	OP	303.25	0.00	218.71	0.00	0.00	0.00	214.06	0.00	0.00	335.36	0.00	335.36

COMPLETE EEG			95819	91.74	Russell Medical Center	OP	118.15	223.37	342.89	218.90	405.47	223.37	83.40	223.37	223.37	130.66	83.40	405.47

STREP A AMPLIFIED PROBE			87651	64.02	Russell Medical Center	OP	82.45	35.09	45.47	34.39	0.00	35.09	58.20	35.09	35.09	91.18	0.00	91.18

HPV TEST (HUMAN PAP VIRUS)			87624	167.64	Russell Medical Center	OP	215.90	35.09	45.47	34.39	0.00	35.09	152.40	35.09	35.09	238.76	0.00	238.76

V,ZOSTER 1GG			86787	33.50	Russell Medical Center	OP	43.14	12.88	14.59	12.62	0.00	12.88	30.45	12.88	12.88	47.71	0.00	47.71

CRYTO ANTIGEN SERUM			86641	44.39	Russell Medical Center	OP	57.16	14.41	14.59	14.12	0.00	14.41	40.35	14.41	14.41	63.22	0.00	63.22

CHLAMYDIA CULTURE			86631	23.76	Russell Medical Center	OP	30.60	11.82	14.59	11.58	10.64	11.82	21.60	11.82	11.82	33.84	10.64	33.84

ENDOMYSIAL AB, 1GA			86255	48.51	Russell Medical Center	OP	62.48	12.05	14.59	11.81	0.00	12.05	44.10	12.05	12.05	69.09	0.00	69.09

CLOTTING FACTOR VIII			85240	63.53	Russell Medical Center	OP	81.81	17.90	25.66	17.54	0.00	17.90	57.75	17.90	17.90	90.48	0.00	90.48

TROPONIN I			84484	63.36	Russell Medical Center	OP	81.60	12.47	14.74	12.22	0.00	12.47	57.60	12.47	12.47	90.24	0.00	90.24

ASSAY OF FREE THYROXINE			84439	18.32	Russell Medical Center	OP	23.59	9.02	20.36	8.84	0.00	9.02	16.65	9.02	9.02	26.09	0.00	26.09

T4			84436	40.10	Russell Medical Center	OP	51.64	6.87	20.36	6.73	0.00	6.87	36.45	6.87	6.87	57.11	0.00	57.11

VITAMIN B			84425	85.64	Russell Medical Center	OP	110.29	21.23	14.74	20.81	0.00	21.23	77.85	21.23	21.23	121.97	0.00	121.97

ASSAY OF TESTOSTERONE TOTAL			84403	83.66	Russell Medical Center	OP	107.74	25.81	20.36	25.29	0.00	25.81	76.05	25.81	25.81	119.15	0.00	119.15

ASSAY OF TESTOSTERONE FREE			84402	153.45	Russell Medical Center	OP	197.63	25.47	20.36	24.96	0.00	25.47	139.50	25.47	25.47	218.55	0.00	218.55

PROTEIN TOTAL QUANTITATIVE			84156	34.32	Russell Medical Center	OP	44.20	3.67	6.55	3.60	0.00	3.67	31.20	3.67	3.67	48.88	0.00	48.88

ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL			84153	48.51	Russell Medical Center	OP	62.48	18.39	14.74	18.02	0.00	18.39	44.10	18.39	18.39	69.09	0.00	69.09

IRON BINDING CAPACITY			83550	10.73	Russell Medical Center	OP	13.81	8.74	14.74	8.57	0.00	8.74	9.75	8.74	8.74	15.28	0.00	15.28

ASSAY OF IRON			83540	16.83	Russell Medical Center	OP	21.68	6.47	6.55	6.34	0.00	6.47	15.30	6.47	6.47	23.97	0.00	23.97

ASSAY OF INSULIN TOTAL			83525	26.57	Russell Medical Center	OP	34.21	11.43	20.36	11.20	0.00	11.43	24.15	11.43	11.43	37.84	0.00	37.84

IMMUNOASSAY ANALYTE QUAL/SEMIQUAL MULTIPLE STEP			83516	87.12	Russell Medical Center	OP	112.20	11.53	14.59	11.30	0.00	11.53	79.20	11.53	11.53	124.08	0.00	124.08

HYDROXY-INDOL AC A-5			83497	205.76	Russell Medical Center	OP	264.99	12.90	20.36	12.64	0.00	12.90	187.05	12.90	12.90	293.05	0.00	293.05

HYDROXYCORTICOST			83491	57.75	Russell Medical Center	OP	74.38	17.90	20.36	17.54	0.00	17.90	52.50	17.90	17.90	82.25	0.00	82.25

HEMOGLOBIN GLYCOSYLATED A1C			83036	29.70	Russell Medical Center	OP	38.25	9.71	14.74	9.52	0.00	9.71	27.00	9.71	9.71	42.30	0.00	42.30

GONADOTROPIN LUTEINIZING HORMONE			83002	67.16	Russell Medical Center	OP	86.49	18.52	20.36	18.15	0.00	18.52	61.05	18.52	18.52	95.65	0.00	95.65

FSH SERUM			83001	67.16	Russell Medical Center	OP	86.49	18.58	20.36	18.21	0.00	18.58	61.05	18.58	18.58	95.65	0.00	95.65

GLUCOSE 3HR TOLERANC			82951	101.48	Russell Medical Center	OP	130.69	12.87	14.74	12.61	11.58	12.87	92.25	12.87	12.87	144.53	11.58	144.53

GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP			82947	45.05	Russell Medical Center	OP	58.01	3.93	6.55	3.85	3.54	3.93	40.95	3.93	3.93	64.16	1.77	64.16

VITAMIN B-12			82607	40.10	Russell Medical Center	OP	51.64	15.08	20.36	14.78	0.00	15.08	36.45	15.08	15.08	57.11	0.00	57.11

CREATININE BLOOD			82565	4.46	Russell Medical Center	OP	5.74	5.12	6.55	5.02	0.00	5.12	4.05	5.12	5.12	6.35	0.00	6.55

KEPPRA LEVEL			82542	102.30	Russell Medical Center	OP	131.75	24.09	14.74	23.61	0.00	24.09	93.00	24.09	24.09	145.70	0.00	145.70

CORTISOL TOTAL			82533	43.23	Russell Medical Center	OP	55.68	16.30	20.36	15.97	0.00	16.30	39.30	16.30	16.30	61.57	0.00	61.57

CALCIUM TOTAL			82310	4.46	Russell Medical Center	OP	5.74	5.16	6.55	5.06	0.00	5.16	4.05	5.16	5.16	6.35	0.00	6.55

BILIRUBIN TOTAL			82247	4.46	Russell Medical Center	OP	5.74	5.02	6.55	4.92	0.00	5.02	4.05	5.02	5.02	6.35	0.00	6.55

HEP B SCREEN			82108	83.82	Russell Medical Center	OP	107.95	25.48	17.47	24.97	0.00	25.48	76.20	25.48	25.48	119.38	0.00	119.38

ALBUMIN			82040	5.94	Russell Medical Center	OP	7.65	4.95	6.55	4.85	0.00	4.95	5.40	4.95	4.95	8.46	0.00	8.46

PREGNANCY URINE			81025	28.38	Russell Medical Center	OP	36.55	8.61	4.45	8.44	0.00	8.61	25.80	8.61	8.61	40.42	0.00	40.42

URINE BACTERIA SCREEN			81007	17.82	Russell Medical Center	OP	22.95	29.98	4.45	29.38	0.00	29.98	16.20	29.98	29.98	25.38	0.00	29.98

ACUTE HEPATITIS PANEL			80074	111.71	Russell Medical Center	OP	143.86	47.63	13.65	46.68	0.00	47.63	101.55	47.63	47.63	159.10	0.00	159.10

Acute gi blood loss imaging			78278	478.88	Russell Medical Center	OP	616.74	324.88	1203.38	318.38	589.73	324.88	435.35	324.88	324.88	682.05	318.38	1203.38

Gastric emptying imag study			78265	485.10	Russell Medical Center	OP	624.75	324.88	506.22	318.38	589.73	324.88	441.00	324.88	324.88	690.90	318.38	690.90

Gastric emptying imag study			78264	478.88	Russell Medical Center	OP	616.74	324.88	506.22	318.38	589.73	324.88	435.35	324.88	324.88	682.05	318.38	682.05

Ct bone density axial			77078	266.64	Russell Medical Center	OP	343.40	70.43	125.66	69.03	127.85	70.43	242.40	70.43	70.43	379.76	69.03	379.76

X-rays bone survey infant			77076	132.00	Russell Medical Center	OP	170.00	98.91	77.69	96.93	179.56	98.91	120.00	98.91	98.91	188.00	77.69	188.00

X-rays bone survey complete			77075	194.04	Russell Medical Center	OP	249.90	98.91	162.71	96.93	179.56	98.91	176.40	98.91	98.91	276.36	96.93	276.36

X-rays bone survey limited			77074	66.73	Russell Medical Center	OP	85.94	98.91	77.69	96.93	179.56	98.91	60.66	98.91	98.91	95.03	60.66	179.56

BONE AGE			77072	66.73	Russell Medical Center	OP	85.94	98.91	77.69	96.93	179.56	98.91	60.66	98.91	98.91	95.03	60.66	179.56

Breast tomosynthesis bi			77063	36.96	Russell Medical Center	OP	47.60	22.46	92.27	22.01	22.46	22.46	33.60	22.46	22.46	52.64	22.01	92.27

X-ray of mammary duct			77053	352.14	Russell Medical Center	OP	453.52	205.66	162.71	201.55	373.33	205.66	320.13	205.66	205.66	501.54	162.71	501.54

Mri breast c-+ w/cad bi			77049	1646.04	Russell Medical Center	OP	2119.90	Not Applicable	601.85	Not Applicable	Not Applicable	Not Applicable	1496.40	Not Applicable	Not Applicable	2344.36	601.85	2344.36

Mri breast c-+ w/cad uni			77048	823.02	Russell Medical Center	OP	1059.95	Not Applicable	601.85	Not Applicable	Not Applicable	Not Applicable	748.20	Not Applicable	Not Applicable	1172.18	601.85	1172.18

Mri breast c- bilateral			77047	1257.96	Russell Medical Center	OP	1620.10	205.66	344.84	201.55	373.33	205.66	1143.60	205.66	205.66	1791.64	201.55	1791.64

Mri breast c- unilateral			77046	628.98	Russell Medical Center	OP	810.05	205.66	344.84	201.55	373.33	205.66	571.80	205.66	205.66	895.82	201.55	895.82

FOLLOW UP STUDY			76970	134.30	Russell Medical Center	OP	172.96	98.91	218.71	96.93	179.56	98.91	122.09	98.91	98.91	191.27	96.93	218.71

US GUIDANCE NEEDLE PLACEMENT IMG S &I			76942	251.46	Russell Medical Center	OP	323.85	0.00	157.40	0.00	0.00	0.00	228.60	0.00	0.00	358.14	0.00	358.14

US LMTD JOINT/OTH NONVASC XTR STRUX R-T W/IMG			76882	139.26	Russell Medical Center	OP	179.35	98.91	218.71	96.93	179.56	98.91	126.60	98.91	98.91	198.34	29.24	218.71

US SCROTUM & CONTENTS			76870	197.51	Russell Medical Center	OP	254.36	98.91	218.71	96.93	179.56	98.91	179.55	98.91	98.91	281.30	96.93	281.30

US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE			76856	198.33	Russell Medical Center	OP	255.43	98.91	284.15	96.93	179.56	98.91	180.30	98.91	98.91	282.47	70.89	284.15

US TRANSVAGINAL PREGNANT			76817	197.51	Russell Medical Center	OP	254.36	98.91	138.45	96.93	179.56	98.91	179.55	98.91	98.91	281.30	62.27	281.30

FETAL BPD			76815	197.51	Russell Medical Center	OP	254.36	98.91	138.45	96.93	179.56	98.91	179.55	98.91	98.91	281.30	54.62	281.30

U/S COMP PREGNANCY < 14 WEEKS			76801	165.00	Russell Medical Center	OP	212.50	98.91	138.45	96.93	179.56	98.91	150.00	98.91	98.91	235.00	77.00	235.00

RETROPERITONEUM COMPLETE SCAN			76770	227.70	Russell Medical Center	OP	293.25	98.91	284.15	96.93	179.56	98.91	207.00	98.91	98.91	324.30	73.26	324.30

ABDOMINAL AORTIC ANEURYSM SCRE			76706	163.02	Russell Medical Center	OP	209.95	98.91	218.71	96.93	179.56	98.91	148.20	98.91	98.91	232.18	96.93	232.18

GALLBLADDER ULTRASOUND			76705	197.51	Russell Medical Center	OP	254.36	98.91	218.71	96.93	179.56	98.91	179.55	98.91	98.91	281.30	58.97	281.30

US BREAST UNI REAL TIME WITH IMAGE LIMITED			76642	316.80	Russell Medical Center	OP	408.00	70.43	218.71	69.03	127.85	70.43	288.00	70.43	70.43	451.20	56.94	451.20

CHEST COMPLETE			76604	197.34	Russell Medical Center	OP	254.15	98.91	218.71	96.93	179.56	98.91	179.40	98.91	98.91	281.06	96.93	281.06

US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM			76536	197.51	Russell Medical Center	OP	254.36	98.91	218.71	96.93	179.56	98.91	179.55	98.91	98.91	281.30	96.93	281.30

LEFT EYE US			76512	197.51	Russell Medical Center	OP	254.36	98.91	218.71	96.93	179.56	98.91	179.55	98.91	98.91	281.30	96.93	281.30

CYSTOGRAM			74430	284.46	Russell Medical Center	OP	366.35	336.99	162.71	330.25	611.73	336.99	258.60	336.99	336.99	405.14	162.71	611.73

TOMOGRAM 11 TO 20 IMAGES			74415	273.90	Russell Medical Center	OP	352.75	160.81	162.71	157.60	291.92	160.81	249.00	160.81	160.81	390.10	157.60	390.10

Radiologic Examination Colon with air contrast			74280	257.90	Russell Medical Center	OP	332.14	160.81	162.71	157.60	291.92	160.81	234.45	160.81	160.81	367.31	157.60	367.31

Radiologic Examination Colon with Barium Enema			74270	196.19	Russell Medical Center	OP	252.66	160.81	162.71	157.60	291.92	160.81	178.35	160.81	160.81	279.42	157.60	291.92

X-ray of small intestine by small bowel tube			74251	280.12	Russell Medical Center	OP	360.76	160.81	162.71	157.60	291.92	160.81	254.65	160.81	160.81	398.95	157.60	398.95

X-ray exam small intestine contrast			74250	127.84	Russell Medical Center	OP	164.65	160.81	162.71	157.60	291.92	160.81	116.22	160.81	160.81	182.08	116.22	291.92

X-ray upper gastrointestinal tract			74248	265.32	Russell Medical Center	OP	341.70	0.00	162.71	0.00	0.00	0.00	241.20	0.00	0.00	377.88	0.00	377.88

X-ray gastrointestinal tract upper air contrast with high density barium			74246	193.38	Russell Medical Center	OP	249.05	160.81	162.71	157.60	291.92	160.81	175.80	160.81	160.81	275.42	157.60	291.92

X-ray exam gastrointestinal tract upper without KUB			74240	265.32	Russell Medical Center	OP	341.70	160.81	162.71	157.60	291.92	160.81	241.20	160.81	160.81	377.88	157.60	377.88

Esophogram single contrast study			74220	146.19	Russell Medical Center	OP	188.28	160.81	77.69	157.60	291.92	160.81	132.90	160.81	160.81	208.21	77.69	291.92

CT abdomen & pelvis			74178	864.60	Russell Medical Center	OP	1113.50	336.99	423.54	330.25	611.73	336.99	786.00	336.99	336.99	1231.40	330.25	1231.40

CT abdomen & pelvis without contrast			74176	603.24	Russell Medical Center	OP	776.90	205.66	423.54	201.55	373.33	205.66	548.40	205.66	205.66	859.16	201.55	859.16

CT angio abdomen with and without contrast			74175	504.15	Russell Medical Center	OP	649.29	160.81	446.71	157.60	291.92	160.81	458.32	160.81	160.81	718.04	157.60	718.04

CT angio abdomen & pelvis with and without contrast			74174	1037.52	Russell Medical Center	OP	1336.20	336.99	446.71	330.25	611.73	336.99	943.20	336.99	336.99	1477.68	330.25	1477.68

CT abdomen with and without contrast			74170	784.08	Russell Medical Center	OP	1009.80	160.81	423.54	157.60	291.92	160.81	712.80	160.81	160.81	1116.72	157.60	1116.72

CT abdomen with contrast			74160	766.92	Russell Medical Center	OP	987.70	160.81	423.54	157.60	291.92	160.81	697.20	160.81	160.81	1092.28	157.60	1092.28

CT abdomen without contrast			74150	460.68	Russell Medical Center	OP	593.30	98.91	163.57	96.93	179.56	98.91	418.80	98.91	98.91	656.12	96.93	656.12

X-ray exam complete abdomen			74022	147.18	Russell Medical Center	OP	189.55	98.91	77.69	96.93	179.56	98.91	133.80	98.91	98.91	209.62	31.23	209.62

X-ray exam abdomen 3+ views			74021	170.94	Russell Medical Center	OP	220.15	98.91	77.69	96.93	179.56	98.91	155.40	98.91	98.91	243.46	77.69	243.46

X-ray exam abdomen 2 views			74019	170.94	Russell Medical Center	OP	220.15	98.91	77.69	96.93	179.56	98.91	155.40	98.91	98.91	243.46	23.15	243.46

X-ray exam abdomen 1 view			74018	89.10	Russell Medical Center	OP	114.75	70.43	77.69	69.03	127.85	70.43	81.00	70.43	70.43	126.90	18.76	127.85

MRI joint lower extremity with and without contrast			73723	2463.12	Russell Medical Center	OP	3172.20	336.99	601.85	330.25	611.73	336.99	2239.20	336.99	336.99	3508.08	330.25	3508.08

MRI joint of lower extremity with contrast			73722	1438.14	Russell Medical Center	OP	1852.15	600.84	601.85	588.82	1090.67	600.84	1307.40	600.84	600.84	2048.26	588.82	2048.26

MRI lower extremity with and without contrast			73720	2463.12	Russell Medical Center	OP	3172.20	336.99	601.85	330.25	611.73	336.99	2239.20	336.99	336.99	3508.08	330.25	3508.08

MRI lower extremity with contrast			73719	1438.14	Russell Medical Center	OP	1852.15	336.99	601.85	330.25	611.73	336.99	1307.40	336.99	336.99	2048.26	330.25	2048.26

MRI lower extremity without contrast			73718	1353.66	Russell Medical Center	OP	1743.35	205.66	344.84	201.55	373.33	205.66	1230.60	205.66	205.66	1927.94	201.55	1927.94

X-ray exam of toe(s)			73660	37.45	Russell Medical Center	OP	48.23	70.43	77.69	69.03	127.85	70.43	34.04	70.43	70.43	53.34	17.45	127.85

X-ray exam of heel 2 views			73650	66.73	Russell Medical Center	OP	85.94	70.43	77.69	69.03	127.85	70.43	60.66	70.43	70.43	95.03	18.04	127.85

X-ray exam of foot complete			73630	82.17	Russell Medical Center	OP	105.83	70.43	77.69	69.03	127.85	70.43	74.70	70.43	70.43	117.03	20.98	127.85

X-ray exam of foot 2 views			73620	79.20	Russell Medical Center	OP	102.00	70.43	77.69	69.03	127.85	70.43	72.00	70.43	70.43	112.80	17.82	127.85

X-ray exam of ankle complete			73610	90.42	Russell Medical Center	OP	116.45	70.43	77.69	69.03	127.85	70.43	82.20	70.43	70.43	128.78	22.28	128.78

X-ray exam of ankle 2 views			73600	66.73	Russell Medical Center	OP	85.94	70.43	77.69	69.03	127.85	70.43	60.66	70.43	70.43	95.03	20.29	127.85

X-ray exam of lower leg			73590	82.17	Russell Medical Center	OP	105.83	70.43	77.69	69.03	127.85	70.43	74.70	70.43	70.43	117.03	19.61	127.85

Contrast x-ray of knee joint			73580	417.91	Russell Medical Center	OP	538.22	336.99	162.71	330.25	611.73	336.99	379.92	336.99	336.99	595.21	162.71	611.73

X-ray exam of knees			73565	66.73	Russell Medical Center	OP	85.94	70.43	77.69	69.03	127.85	70.43	60.66	70.43	70.43	95.03	60.66	127.85

X-ray exam knee 4 or more			73564	99.33	Russell Medical Center	OP	127.93	98.91	77.69	96.93	179.56	98.91	90.30	98.91	98.91	141.47	27.10	179.56

X-ray exam of knee 1 or 2			73560	82.17	Russell Medical Center	OP	105.83	70.43	77.69	69.03	127.85	70.43	74.70	70.43	70.43	117.03	21.41	127.85

X-ray exam of femur 2			73552	88.72	Russell Medical Center	OP	114.26	70.43	77.69	69.03	127.85	70.43	80.65	70.43	70.43	126.35	22.13	127.85

X-ray exam of femur 1			73551	88.72	Russell Medical Center	OP	114.26	70.43	77.69	69.03	127.85	70.43	80.65	70.43	70.43	126.35	18.71	127.85

Contrast x-ray of hip			73525	495.66	Russell Medical Center	OP	638.35	336.99	162.71	330.25	611.73	336.99	450.60	336.99	336.99	705.94	162.71	705.94

X-ray exam hips bilateral 5 views			73523	279.84	Russell Medical Center	OP	360.40	98.91	77.69	96.93	179.56	98.91	254.40	98.91	98.91	398.56	37.94	398.56

X-ray exam hips bilateral 3-4 views			73522	147.18	Russell Medical Center	OP	189.55	98.91	77.69	96.93	179.56	98.91	133.80	98.91	98.91	209.62	33.40	209.62

X-ray exam hips bilateral 2 views			73521	147.18	Russell Medical Center	OP	189.55	98.91	77.69	96.93	179.56	98.91	133.80	98.91	98.91	209.62	25.59	209.62

X-ray exam hip unilateral 4 views			73503	146.93	Russell Medical Center	OP	189.23	98.91	77.69	96.93	179.56	98.91	133.57	98.91	98.91	209.26	35.83	209.26

X-ray exam hip unilateral 2-3 views			73502	88.44	Russell Medical Center	OP	113.90	70.43	77.69	69.03	127.85	70.43	80.40	70.43	70.43	125.96	28.97	127.85

X-ray exam hip unilateral 1 view			73501	88.44	Russell Medical Center	OP	113.90	70.43	77.69	69.03	127.85	70.43	80.40	70.43	70.43	125.96	20.34	127.85

Mr angio upper extremity with and without contrast			73225	953.70	Russell Medical Center	OP	1228.25	Not Applicable	585.08	Not Applicable	Not Applicable	Not Applicable	867.00	Not Applicable	Not Applicable	1358.30	585.08	1358.30

MRI joint upper extremity with and without contrast			73223	2463.12	Russell Medical Center	OP	3172.20	336.99	601.85	330.25	611.73	336.99	2239.20	336.99	336.99	3508.08	330.25	3508.08

MRI joint upper extremity with contrast			73222	1438.14	Russell Medical Center	OP	1852.15	600.84	601.85	588.82	1090.67	600.84	1307.40	600.84	600.84	2048.26	588.82	2048.26

MRI joint upper extremity without contrast			73221	1353.66	Russell Medical Center	OP	1743.35	205.66	344.84	201.55	373.33	205.66	1230.60	205.66	205.66	1927.94	201.55	1927.94

MRI upper extremity withou and without contrast			73220	2463.12	Russell Medical Center	OP	3172.20	336.99	601.85	330.25	611.73	336.99	2239.20	336.99	336.99	3508.08	330.25	3508.08

MRI upper extremity with contrast			73219	1423.62	Russell Medical Center	OP	1833.45	336.99	601.85	330.25	611.73	336.99	1294.20	336.99	336.99	2027.58	330.25	2027.58

MRI upper extremity without contrast			73218	1339.14	Russell Medical Center	OP	1724.65	205.66	344.84	201.55	373.33	205.66	1217.40	205.66	205.66	1907.26	201.55	1907.26

CT upper extremity with and without contrast			73202	623.04	Russell Medical Center	OP	802.40	160.81	423.54	157.60	291.92	160.81	566.40	160.81	160.81	887.36	157.60	887.36

CT upper extremity with contrast			73201	595.32	Russell Medical Center	OP	766.70	336.99	423.54	330.25	611.73	336.99	541.20	336.99	336.99	847.88	330.25	847.88

CT upper extremity without contrast			73200	439.56	Russell Medical Center	OP	566.10	98.91	163.57	96.93	179.56	98.91	399.60	98.91	98.91	626.04	96.93	626.04

X-ray exam of finger(s)			73140	68.15	Russell Medical Center	OP	87.76	70.43	77.69	69.03	127.85	70.43	61.95	70.43	70.43	97.06	17.45	127.85

X-ray exam of hand 3 views			73130	82.17	Russell Medical Center	OP	105.83	70.43	77.69	69.03	127.85	70.43	74.70	70.43	70.43	117.03	22.28	127.85

X-ray exam of hand 2 views			73120	79.20	Russell Medical Center	OP	102.00	98.91	77.69	96.93	179.56	98.91	72.00	98.91	98.91	112.80	72.00	179.56

Contrast x-ray of wrist			73115	496.00	Russell Medical Center	OP	638.79	336.99	162.71	330.25	611.73	336.99	450.91	336.99	336.99	706.43	162.71	706.43

X-ray exam of wrist complete			73110	82.17	Russell Medical Center	OP	105.83	70.43	77.69	69.03	127.85	70.43	74.70	70.43	70.43	117.03	22.28	127.85

X-ray exam of wrist 2 views			73100	66.73	Russell Medical Center	OP	85.94	70.43	77.69	69.03	127.85	70.43	60.66	70.43	70.43	95.03	20.60	127.85

X-ray exam of arm infant			73092	82.17	Russell Medical Center	OP	105.83	98.91	77.69	96.93	179.56	98.91	74.70	98.91	98.91	117.03	74.70	179.56

X-ray exam of forearm			73090	82.17	Russell Medical Center	OP	105.83	70.43	77.69	69.03	127.85	70.43	74.70	70.43	70.43	117.03	18.49	127.85

Contrast x-ray of elbow			73085	559.02	Russell Medical Center	OP	719.95	336.99	162.71	330.25	611.73	336.99	508.20	336.99	336.99	796.18	162.71	796.18

X-ray exam of elbow complete			73080	82.17	Russell Medical Center	OP	105.83	70.43	77.69	69.03	127.85	70.43	74.70	70.43	70.43	117.03	19.86	127.85

X-ray exam of elbow 2 views			73070	66.73	Russell Medical Center	OP	85.94	70.43	77.69	69.03	127.85	70.43	60.66	70.43	70.43	95.03	18.26	127.85

X-ray exam of humerus			73060	82.17	Russell Medical Center	OP	105.83	70.43	77.69	69.03	127.85	70.43	74.70	70.43	70.43	117.03	20.06	127.85

X-ray exam of AC Joints Bilateral			73050	90.92	Russell Medical Center	OP	117.09	70.43	77.69	69.03	127.85	70.43	82.65	70.43	70.43	129.49	20.11	129.49

Contrast x-ray of shoulder and arthrography			73040	417.91	Russell Medical Center	OP	538.22	336.99	162.71	330.25	611.73	336.99	379.92	336.99	336.99	595.21	162.71	611.73

X-ray exam of shoulder comlpete 2+ views			73030	89.76	Russell Medical Center	OP	115.60	70.43	77.69	69.03	127.85	70.43	81.60	70.43	70.43	127.84	21.23	127.85

X-ray exam of shoulder 1 view			73020	66.73	Russell Medical Center	OP	85.94	70.43	77.69	69.03	127.85	70.43	60.66	70.43	70.43	95.03	13.75	127.85

X-ray exam of shoulder blade			73010	82.17	Russell Medical Center	OP	105.83	98.91	77.69	96.93	179.56	98.91	74.70	98.91	98.91	117.03	17.84	179.56

X-ray exam of collar bone			73000	82.17	Russell Medical Center	OP	105.83	70.43	77.69	69.03	127.85	70.43	74.70	70.43	70.43	117.03	20.06	127.85

X-ray exam tailbone			72220	104.28	Russell Medical Center	OP	134.30	70.43	77.69	69.03	127.85	70.43	94.80	70.43	70.43	148.52	20.08	148.52

X-ray exam si joints 3 views			72202	103.95	Russell Medical Center	OP	133.88	98.91	77.69	96.93	179.56	98.91	94.50	98.91	98.91	148.05	24.50	179.56

MRI pelvis with contrast			72196	1909.38	Russell Medical Center	OP	2459.05	336.99	601.85	330.25	611.73	336.99	1735.80	336.99	336.99	2719.42	330.25	2719.42

MRI pelvis without contrast			72195	1353.66	Russell Medical Center	OP	1743.35	205.66	344.84	201.55	373.33	205.66	1230.60	205.66	205.66	1927.94	201.55	1927.94

CT pelvis with and without contrast			72194	829.62	Russell Medical Center	OP	1068.45	160.81	423.54	157.60	291.92	160.81	754.20	160.81	160.81	1181.58	157.60	1181.58

CT pelvis without contrast			72192	413.16	Russell Medical Center	OP	532.10	98.91	163.57	96.93	179.56	98.91	375.60	98.91	98.91	588.44	96.93	588.44

X-ray exam of pelvis			72170	112.43	Russell Medical Center	OP	144.80	98.91	77.69	96.93	179.56	98.91	102.21	98.91	98.91	160.13	18.28	179.56

MRI lumbar spine with and without contrast			72158	2463.12	Russell Medical Center	OP	3172.20	336.99	601.85	330.25	611.73	336.99	2239.20	336.99	336.99	3508.08	330.25	3508.08

MRI chest spine with and without contrast			72157	2463.12	Russell Medical Center	OP	3172.20	336.99	601.85	330.25	611.73	336.99	2239.20	336.99	336.99	3508.08	330.25	3508.08

MRI neck spine without and with contrast			72156	2463.12	Russell Medical Center	OP	3172.20	336.99	601.85	330.25	611.73	336.99	2239.20	336.99	336.99	3508.08	330.25	3508.08

MRI lumbar spine with contrast			72149	1909.38	Russell Medical Center	OP	2459.05	336.99	601.85	330.25	611.73	336.99	1735.80	336.99	336.99	2719.42	330.25	2719.42

MRI chest spine with contrast			72147	1889.58	Russell Medical Center	OP	2433.55	336.99	601.85	330.25	611.73	336.99	1717.80	336.99	336.99	2691.22	330.25	2691.22

MRI chest spine without contrast			72146	1353.66	Russell Medical Center	OP	1743.35	205.66	344.84	201.55	373.33	205.66	1230.60	205.66	205.66	1927.94	201.55	1927.94

MRI neck spine with contrast			72142	1909.38	Russell Medical Center	OP	2459.05	336.99	601.85	330.25	611.73	336.99	1735.80	336.99	336.99	2719.42	330.25	2719.42

MRI neck spine without contrast			72141	1353.66	Russell Medical Center	OP	1743.35	205.66	344.84	201.55	373.33	205.66	1230.60	205.66	205.66	1927.94	201.55	1927.94

CT lumbar spine with and without contrast			72133	925.32	Russell Medical Center	OP	1191.70	160.81	423.54	157.60	291.92	160.81	841.20	160.81	160.81	1317.88	157.60	1317.88

CT lumbar spine with contrast			72132	650.76	Russell Medical Center	OP	838.10	336.99	423.54	330.25	611.73	336.99	591.60	336.99	336.99	926.84	330.25	926.84

CT lumbar spine without contrast			72131	619.74	Russell Medical Center	OP	798.15	98.91	163.57	96.93	179.56	98.91	563.40	98.91	98.91	882.66	96.93	882.66

CT chest spine with and without contrast			72130	1011.78	Russell Medical Center	OP	1303.05	160.81	423.54	157.60	291.92	160.81	919.80	160.81	160.81	1441.02	157.60	1441.02

CT chest spine with contrast			72129	875.82	Russell Medical Center	OP	1127.95	160.81	423.54	157.60	291.92	160.81	796.20	160.81	160.81	1247.38	157.60	1247.38

CT chest spine without contrast			72128	619.74	Russell Medical Center	OP	798.15	98.91	163.57	96.93	179.56	98.91	563.40	98.91	98.91	882.66	96.93	882.66

CT neck spine with and without contrast			72127	497.61	Russell Medical Center	OP	640.86	160.81	423.54	157.60	291.92	160.81	452.37	160.81	160.81	708.71	157.60	708.71

CT neck spine with contrast			72126	447.58	Russell Medical Center	OP	576.43	336.99	423.54	330.25	611.73	336.99	406.89	336.99	336.99	637.46	330.25	637.46

CT neck spine without contrast			72125	619.74	Russell Medical Center	OP	798.15	98.91	163.57	96.93	179.56	98.91	563.40	98.91	98.91	882.66	96.93	882.66

X-ray bend only lumbosacral spine			72120	68.31	Russell Medical Center	OP	87.98	98.91	77.69	96.93	179.56	98.91	62.10	98.91	98.91	97.29	62.10	179.56

X-ray exam lumbosacral spine complete			72114	112.43	Russell Medical Center	OP	144.80	98.91	77.69	96.93	179.56	98.91	102.21	98.91	98.91	160.13	77.69	179.56

X-ray exam lumbosacral spine 2-3 views			72100	68.15	Russell Medical Center	OP	87.76	98.91	77.69	96.93	179.56	98.91	61.95	98.91	98.91	97.06	24.47	179.56

X-ray exam entire spine 4-5 views			72083	352.14	Russell Medical Center	OP	453.52	98.91	77.69	96.93	179.56	98.91	320.13	98.91	98.91	501.54	50.34	501.54

X-ray exam entire spine 2-3 views			72082	352.14	Russell Medical Center	OP	453.52	98.91	77.69	96.93	179.56	98.91	320.13	98.91	98.91	501.54	43.29	501.54

X-ray exam thorac spine 3 views			72072	99.33	Russell Medical Center	OP	127.93	98.91	77.69	96.93	179.56	98.91	90.30	98.91	98.91	141.47	24.72	179.56

X-ray exam neck spine 6 views			72052	112.43	Russell Medical Center	OP	144.80	98.91	77.69	96.93	179.56	98.91	102.21	98.91	98.91	160.13	77.69	179.56

X-ray exam neck spine 4-5 views			72050	146.19	Russell Medical Center	OP	188.28	98.91	77.69	96.93	179.56	98.91	132.90	98.91	98.91	208.21	32.45	208.21

X-ray exam neck spine 2-3 view			72040	77.22	Russell Medical Center	OP	99.45	70.43	77.69	69.03	127.85	70.43	70.20	70.43	70.43	109.98	24.47	127.85

X-ray exam of spine 1 view			72020	127.84	Russell Medical Center	OP	164.65	70.43	77.69	69.03	127.85	70.43	116.22	70.43	70.43	182.08	69.03	182.08

MRI chest with and without contrast			71552	2463.12	Russell Medical Center	OP	3172.20	336.99	601.85	330.25	611.73	336.99	2239.20	336.99	336.99	3508.08	330.25	3508.08

MRI chest with contrast			71551	1909.38	Russell Medical Center	OP	2459.05	600.84	601.85	588.82	1090.67	600.84	1735.80	600.84	600.84	2719.42	588.82	2719.42

MRI chest without contrast			71550	1339.14	Russell Medical Center	OP	1724.65	205.66	344.84	201.55	373.33	205.66	1217.40	205.66	205.66	1907.26	201.55	1907.26

CT thorax with and without contrast			71270	605.88	Russell Medical Center	OP	780.30	160.81	423.54	157.60	291.92	160.81	550.80	160.81	160.81	862.92	157.60	862.92

CT thorax with contrast			71260	560.34	Russell Medical Center	OP	721.65	160.81	423.54	157.60	291.92	160.81	509.40	160.81	160.81	798.06	157.60	798.06

CT thorax without contrast			71250	347.82	Russell Medical Center	OP	447.95	98.91	163.57	96.93	179.56	98.91	316.20	98.91	98.91	495.38	96.93	495.38

X-ray strenoclavic joint 3 views			71130	82.50	Russell Medical Center	OP	106.25	70.43	77.69	69.03	127.85	70.43	75.00	70.43	70.43	117.50	25.59	127.85

X-ray exam breastbone 2 views			71120	82.17	Russell Medical Center	OP	105.83	70.43	77.69	69.03	127.85	70.43	74.70	70.43	70.43	117.03	21.06	127.85

X-ray exam ribs and/ or chest 4 views			71111	155.93	Russell Medical Center	OP	200.81	98.91	77.69	96.93	179.56	98.91	141.75	98.91	98.91	222.08	33.03	222.08

X-ray exam ribs bilateral 3 views			71110	81.84	Russell Medical Center	OP	105.40	98.91	77.69	96.93	179.56	98.91	74.40	98.91	98.91	116.56	74.40	179.56

X-ray exam unilateral ribs and chest			71101	128.54	Russell Medical Center	OP	165.54	98.91	77.69	96.93	179.56	98.91	116.85	98.91	98.91	183.07	26.39	183.07

X-ray exam ribs unilateral 2 views			71100	82.17	Russell Medical Center	OP	105.83	70.43	77.69	69.03	127.85	70.43	74.70	70.43	70.43	117.03	22.90	127.85

X-ray exam chest 4+ views			71048	170.94	Russell Medical Center	OP	220.15	98.91	77.69	96.93	179.56	98.91	155.40	98.91	98.91	243.46	77.69	243.46

X-ray exam chest 3 views			71047	89.10	Russell Medical Center	OP	114.75	70.43	77.69	69.03	127.85	70.43	81.00	70.43	70.43	126.90	69.03	127.85

X-ray exam chest 2 views			71046	89.10	Russell Medical Center	OP	114.75	70.43	77.69	69.03	127.85	70.43	81.00	70.43	70.43	126.90	21.11	127.85

X-ray exam chest 1 view			71045	89.10	Russell Medical Center	OP	114.75	70.43	77.69	69.03	127.85	70.43	81.00	70.43	70.43	126.90	16.09	127.85

MRI orbit/face/neck with contrast			70542	1909.38	Russell Medical Center	OP	2459.05	336.99	601.85	330.25	611.73	336.99	1735.80	336.99	336.99	2719.42	330.25	2719.42

MRI orbit/face/neck without contrast			70540	1353.66	Russell Medical Center	OP	1743.35	205.66	344.84	201.55	373.33	205.66	1230.60	205.66	205.66	1927.94	201.55	1927.94

CT soft tissue of neck with and without contrast			70492	830.94	Russell Medical Center	OP	1070.15	160.81	423.54	157.60	291.92	160.81	755.40	160.81	160.81	1183.46	157.60	1183.46

CT soft tissue neck with contrast			70491	571.56	Russell Medical Center	OP	736.10	160.81	423.54	157.60	291.92	160.81	519.60	160.81	160.81	814.04	157.60	814.04

CT soft tissue neck without contrast			70490	413.16	Russell Medical Center	OP	532.10	98.91	163.57	96.93	179.56	98.91	375.60	98.91	98.91	588.44	96.93	588.44

CT maxillofacial with and without contrast			70488	896.28	Russell Medical Center	OP	1154.30	160.81	423.54	157.60	291.92	160.81	814.80	160.81	160.81	1276.52	157.60	1276.52

CT maxillofacial with contrast			70487	778.14	Russell Medical Center	OP	1002.15	160.81	423.54	157.60	291.92	160.81	707.40	160.81	160.81	1108.26	157.60	1108.26

CT maxillofacial without contrast			70486	476.52	Russell Medical Center	OP	613.70	98.91	163.57	96.93	179.56	98.91	433.20	98.91	98.91	678.68	96.93	678.68

CT orbit or ear with and without contrast			70482	655.38	Russell Medical Center	OP	844.05	160.81	423.54	157.60	291.92	160.81	595.80	160.81	160.81	933.42	157.60	933.42

CT orbit or ear with contrast			70481	554.40	Russell Medical Center	OP	714.00	160.81	423.54	157.60	291.92	160.81	504.00	160.81	160.81	789.60	157.60	789.60

CT orbit or ear without contrast			70480	509.52	Russell Medical Center	OP	656.20	98.91	163.57	96.93	179.56	98.91	463.20	98.91	98.91	725.68	96.93	725.68

CT head or brain without and with contrast			70470	838.86	Russell Medical Center	OP	1080.35	160.81	423.54	157.60	291.92	160.81	762.60	160.81	160.81	1194.74	157.60	1194.74

CT head or brain with contrast			70460	570.90	Russell Medical Center	OP	735.25	160.81	423.54	157.60	291.92	160.81	519.00	160.81	160.81	813.10	157.60	813.10

EKG Routine with 12+ leads (interpretation & report)			93010	23.76	Russell Medical Center	OP	30.60	Not Applicable	36.66	Not Applicable	Not Applicable	Not Applicable	21.60	Not Applicable	Not Applicable	33.84	6.99	36.66

Complete EEG-Sleep Deprived			95816	358.38	Russell Medical Center	OP	461.55	223.37	342.89	218.90	405.47	223.37	325.80	223.37	223.37	510.42	127.00	510.42

Tumor Wholebody Single			78802	1852.62	Russell Medical Center	OP	2385.95	1122.73	1203.38	1100.28	2038.04	1122.73	1684.20	1122.73	1122.73	2638.58	1100.28	2638.58

Echo Stress			93350	651.42	Russell Medical Center	OP	838.95	425.00	673.61	416.50	771.49	425.00	592.20	425.00	425.00	927.78	416.50	927.78

Echo Doppler Limited			93321	215.48	Russell Medical Center	OP	277.52	0.00	673.61	0.00	0.00	0.00	195.89	0.00	0.00	306.90	0.00	673.61

ECG Non-Monitored			93797	159.72	Russell Medical Center	OP	205.70	97.10	215.44	95.16	176.27	97.10	145.20	97.10	97.10	227.48	95.16	227.48

6 Minute Walk Test			94618	151.14	Russell Medical Center	OP	194.65	96.22	342.65	94.30	174.67	96.22	137.40	96.22	96.22	215.26	27.16	342.65

CT Angiography Neck			70498	504.15	Russell Medical Center	OP	649.29	160.81	446.71	157.60	291.92	160.81	458.32	160.81	160.81	718.04	157.60	718.04

T-Spine without Constrast			72128	619.74	Russell Medical Center	OP	798.15	98.91	163.57	96.93	179.56	98.91	563.40	98.91	98.91	882.66	96.93	882.66

CT Coronary Angiography with/ without Calcium			75574	655.38	Russell Medical Center	OP	844.05	160.81	446.71	157.60	291.92	160.81	595.80	160.81	160.81	933.42	157.60	933.42

CT Heart without Contrast Calcium			75571	85.80	Russell Medical Center	OP	110.50	70.43	163.57	69.03	127.85	70.43	78.00	70.43	70.43	122.20	69.03	163.57

CT Angiography Chest			71275	560.34	Russell Medical Center	OP	721.65	160.81	446.71	157.60	291.92	160.81	509.40	160.81	160.81	798.06	157.60	798.06

CT Angiography Pelvis			72191	504.15	Russell Medical Center	OP	649.29	160.81	446.71	157.60	291.92	160.81	458.32	160.81	160.81	718.04	157.60	718.04

CT Angiography Abdominal Arteries			75635	504.15	Russell Medical Center	OP	649.29	160.81	446.71	157.60	291.92	160.81	458.32	160.81	160.81	718.04	157.60	718.04

CT Guide For Needle Placement			77012	730.62	Russell Medical Center	OP	940.95	0.00	143.83	0.00	0.00	0.00	664.20	0.00	0.00	1040.58	0.00	1040.58

Fine Needle Aspiration Biopsy			10010	79.86	Russell Medical Center	OP	102.85	0.00	878.20	0.00	0.00	0.00	72.60	0.00	0.00	113.74	0.00	878.20

MRI MRA Brain Without Contrast			70551	2399.76	Russell Medical Center	OP	3090.60	205.66	344.84	201.55	373.33	205.66	2181.60	205.66	205.66	3417.84	201.55	3417.84

MRA Neck Without Contrast			70547	1046.10	Russell Medical Center	OP	1347.25	205.66	585.08	201.55	373.33	205.66	951.00	205.66	205.66	1489.90	201.55	1489.90

MRI IACS WITH CONTRAST			70552	1909.38	Russell Medical Center	OP	2459.05	336.99	601.85	330.25	611.73	336.99	1735.80	336.99	336.99	2719.42	330.25	2719.42

Cardiac valve and other major cardiothoracic procedures with cardiac catheterization with major complications or comorbidities			216	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided

Routine obstetric care for vaginal delivery after prior cesarean delivery including pre-and post-delivery care			59610	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided

Obstetric blood test panel			80055	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided

Psychotherapy, 30 min			90832	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided

Psychotherapy, 45 min			90834	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided

Psychotherapy, 60 min			90837	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided

Family psychotherapy, not including patient, 50 min			90846	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided

Family psychotherapy, including patient, 50 min			90847	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided

Group psychotherapy			90853	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided

Repair of groin hernia patient age 5 years or older	Primary Procedure	360	49505	1793.88	Russell Medical Center	OP	2310.30	2744.05	3390.58	2689.17	4981.15	2744.05	1630.80	2744.05	2744.05	2554.92	426.59	4981.15
	Pharmacy	250		476.92	Russell Medical Center	OP	614.21	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	433.56	Not Applicable	Not Applicable	679.24	433.56	679.24
	Supplies	270		1026.00	Russell Medical Center	OP	1321.37	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	932.73	Not Applicable	Not Applicable	1461.28	932.73	1461.28
	Supplies	272		363.86	Russell Medical Center	OP	468.61	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	330.78	Not Applicable	Not Applicable	518.22	330.78	518.22
	Pharmacy	636	J0330	11.22	Russell Medical Center	OP	14.45	0.00	0.00	0.00	0.00	0.00	10.20	0.00	0.00	15.98	0.00	15.98
	Pharmacy	636	J2405	79.86	Russell Medical Center	OP	102.85	0.00	0.00	0.00	0.00	0.00	72.60	0.00	0.00	113.74	0.00	113.74
	Pharmacy	636	J1100	12.87	Russell Medical Center	OP	16.58	0.00	0.00	0.00	0.00	0.00	11.70	0.00	0.00	18.33	0.00	18.33
	Pharmacy	636	J0690	16.50	Russell Medical Center	OP	21.25	0.00	0.00	0.00	0.00	0.00	15.00	0.00	0.00	23.50	0.00	23.50
	Pharmacy	636	J3010	11.22	Russell Medical Center	OP	14.45	0.00	0.00	0.00	0.00	0.00	10.20	0.00	0.00	15.98	0.00	15.98
	Pharmacy	637	A9270	2.15	Russell Medical Center	OP	2.76	0.00	0.00	0.00	0.00	0.00	1.95	0.00	0.00	3.06	0.00	3.06
	Recovery Room	710		377.52	Russell Medical Center	OP	486.20	Not Applicable	Not Applicable	Not Applicable	Not Applicable	Not Applicable	343.20	Not Applicable	Not Applicable	537.68	343.20	537.68

Surgical removal of prostate and surrounding lymph nodes using an endoscope	Primary Procedure		55866	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided

Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance	Primary Procedure		64483	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided

Cervical spinal fusion without comorbid conditions (CC) or major comorbid conditions or complications (MCC).	MS-DRG		473	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided

Removal of recurring cataract in lens capsule using laser	Primary Procedure		66821	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided

Ultrasound examination of lower large bowel using an endoscope	Primary Procedure		45391	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided	Service not provided

Routine obstetric care for vaginal delivery, including pre-and post- delivery care	Primary Procedure		59400	1821.60	Russell Medical Center	OP	2210.00	Not Applicable	2208.00	Not Applicable	1643.12	1727.31	1656.00	Not Applicable	2049.54	2594.40	1643.12	2659.25

Routine obstetric care for cesarean delivery, including pre-and post-delivery care	Primary Procedure		59510	1821.60	Russell Medical Center	OP	2210.00	Not Applicable	2268.19	Not Applicable	1862.67	1911.56	1656.00	Not Applicable	2268.19	2594.40	1656.00	3403.14

Electrocardiogram, routine, with interpretation and report	Primary Procedure		93000	34.98	Russell Medical Center	OP	42.00	Not Applicable	33.12	Not Applicable	25.54	13.48	31.80	0.00	15.95	49.82	0.00	49.82

MRI Pelvis With & Without Contrast			72197	2016.30	Russell Medical Center	OP	2596.75	336.99	601.85	330.25	611.73	336.99	1833.00	336.99	336.99	2871.70	330.25	2871.70

TriGlycerides VAP Lab			84478	37.95	Russell Medical Center	OP	48.88	5.74	6.55	5.63	5.17	5.74	34.50	5.74	5.74	54.05	5.17	54.05

Potassium			84132	4.46	Russell Medical Center	OP	5.74	4.76	6.55	4.66	0.00	4.76	4.05	4.76	4.76	6.35	0.00	6.55

Lyme Disease Test			86617	49.74	Russell Medical Center	OP	64.06	15.49	14.59	15.18	0.00	15.49	45.22	15.49	15.49	70.84	0.00	70.84

MRA Left Lower Extremity with Contrast			73725	1364.88	Russell Medical Center	OP	1757.80	Not Applicable	585.08	Not Applicable	Not Applicable	Not Applicable	1240.80	Not Applicable	Not Applicable	1943.92	585.08	1943.92

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