Welcome to Washington Regional Medical Center, where your health and well-being are our top priorities.

Here at Washington Regional, we believe in transparency when it comes to your healthcare costs. In line with federal guidelines from the Centers for Medicare and Medicaid Services (CMS), we’re dedicated to providing you with clear information to help you navigate your healthcare journey confidently.

Understanding healthcare billing can be complex, especially with the multitude of insurance plans available. That’s why we encourage our valued patients to reach out directly to their insurance provider or connect with our financial services team for personalized estimates. Rest assured, we’re here to assist you every step of the way.

For those without insurance coverage, including Medicare or Medicaid, Washington Regional offers financial assistance options such as discounts or reductions on our standard charges.

As a token of our commitment to your well-being, we’ve compiled some helpful information to shed light on the intricacies of healthcare billing.

What’s not covered in our chargemaster and consumer driven services (shoppable services) list?

It’s important to note that charges for services rendered by the doctor or doctors overseeing your care at our hospital are not included. This means you may receive separate bills from both the hospital and the physicians involved in your treatment.

Here is a sample of some of the healthcare providers who might bill you separately:

• Attending Physicians that may visit during your hospital stay
• Emergency room physicians
• Radiologists interpreting your imaging results
• Other specialists your doctor may consult during your hospitalization
• Pathologists reviewing your specimens

Additionally, certain laboratory testing may not be covered. We want to ensure that you are aware of all potential billing entities so you can plan accordingly and make informed decisions about your healthcare journey.

Price Transparency

At Washington Regional Medical Center, we aim to provide transparency regarding hospital charges to our valued patients. Through our chargemaster, you can access a detailed list of charges for services and items provided at our Plymouth NC Campus. This comprehensive list covers everything from tests and exams to room charges.

While we strive to offer this information in compliance with state and federal guidelines, we understand that it can be overwhelming and may not directly answer questions about actual costs or specific bills. We encourage you to learn more about our chargemaster to better understand how it functions.

It’s important to note that the amounts listed in our chargemaster are typically not what patients are billed. Instead, they are billed to insurance companies, Medicare, or Medicaid, which then apply their negotiated rates. For uninsured patients, our hospital offers discounts. Please contact our financial assistance team for any questions you may have.

Please be aware that while our hospital charges remain consistent for all patients, the actual amount billed and your financial responsibility may vary depending on the specific services provided during each visit and your insurance coverage. Additionally, charges for certain items like medications and supplies may fluctuate throughout the year, potentially resulting in discrepancies between the listed charges and your statement.

The details provided in our chargemaster represent a thorough compilation of charges for both inpatient and outpatient services or items offered at Washington Regional Medical Center. These charges were verified for accuracy as of August 11, 2026.

While our hospital upholds uniform charges for all patients, the final amount billed and your financial responsibility can differ significantly. This variance is influenced by the particular services rendered during each visit and the type of insurance coverage you possess. Additionally, fluctuations in charges for medications, supplies, and other factors throughout the year may result in disparities between the listed charges and what appears on your statement.

Shoppable Services

Washington Regional Medical Center provides pricing information for shoppable services to help patients understand the cost of care before receiving services. The searchable table includes discounted cash prices, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges, as applicable.

Search by service description, billing code, or insurance payer to find pricing information.


To narrow your search, enter multiple search terms separated by a space.
Example: Aetna 90847

Service Description	Charge Description	Service Category	Billing Code	Code Type	CDM Code	Modifier	Location	Setting	Gross Charge	Discounted Cash Price	Payer	Plan	Payer-Specific Negotiated Charge	De-identified Minimum Negotiated Charge	De-identified Maximum Negotiated Charge
Family psychotherapy, including patient, 50 min	Family Psych w/Patient 908477	Evaluation & Management	90847	CPT	2388430		Washington Regional Medical Center	outpatient	319	159.5	Self-Pay	Discounted Cash		112.16	239.25
Family psychotherapy, including patient, 50 min	Family Psych w/Patient 908477	Evaluation & Management	90847	CPT	2388430		Washington Regional Medical Center	outpatient	319	159.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	239.25	112.16	239.25
Family psychotherapy, including patient, 50 min	Family Psych w/Patient 908477	Evaluation & Management	90847	CPT	2388430		Washington Regional Medical Center	outpatient	319	159.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	140.36	112.16	239.25
Family psychotherapy, including patient, 50 min	Family Psych w/Patient 908477	Evaluation & Management	90847	CPT	2388430		Washington Regional Medical Center	outpatient	319	159.5	Humana	Medicare Advantage HMO/PPO/PFFS	149.93	112.16	239.25
Family psychotherapy, including patient, 50 min	Family Psych w/Patient 908477	Evaluation & Management	90847	CPT	2388430		Washington Regional Medical Center	outpatient	319	159.5	AmeriHealth Caritas North Carolina	NC Medicaid	112.16	112.16	239.25
Family psychotherapy, including patient, 50 min	Family Psych w/Patient 908477	Evaluation & Management	90847	CPT	2388430		Washington Regional Medical Center	outpatient	319	159.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	112.16	112.16	239.25
Family psychotherapy, including patient, 50 min	Family Psych w/Patient 908477	Evaluation & Management	90847	CPT	2388430		Washington Regional Medical Center	outpatient	319	159.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	112.16	112.16	239.25
Family psychotherapy, including patient, 50 min	Family Psych w/Patient 908477	Evaluation & Management	90847	CPT	2388430		Washington Regional Medical Center	outpatient	319	159.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	112.16	112.16	239.25
Family psychotherapy, including patient, 50 min	Family Psych w/Patient 908477	Evaluation & Management	90847	CPT	2388430		Washington Regional Medical Center	outpatient	319	159.5	Cigna	North Carolina PPO-PPA Direct	122.77	112.16	239.25
Family psychotherapy, including patient, 50 min	Family Psych w/Patient 908477	Evaluation & Management	90847	CPT	2388430		Washington Regional Medical Center	outpatient	319	159.5	Original Medicare	Traditional Medicare Fee-for-Service	149.93	112.16	239.25
Family psychotherapy, not including patient, 50 min	Family Psych w/o Patient 90846	Evaluation & Management	90846	CPT	2388429		Washington Regional Medical Center	outpatient	387.4	193.7	Self-Pay	Discounted Cash		102.69	290.55
Family psychotherapy, not including patient, 50 min	Family Psych w/o Patient 90846	Evaluation & Management	90846	CPT	2388429		Washington Regional Medical Center	outpatient	387.4	193.7	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	290.55	102.69	290.55
Family psychotherapy, not including patient, 50 min	Family Psych w/o Patient 90846	Evaluation & Management	90846	CPT	2388429		Washington Regional Medical Center	outpatient	387.4	193.7	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	170.46	102.69	290.55
Family psychotherapy, not including patient, 50 min	Family Psych w/o Patient 90846	Evaluation & Management	90846	CPT	2388429		Washington Regional Medical Center	outpatient	387.4	193.7	Humana	Medicare Advantage HMO/PPO/PFFS	182.08	102.69	290.55
Family psychotherapy, not including patient, 50 min	Family Psych w/o Patient 90846	Evaluation & Management	90846	CPT	2388429		Washington Regional Medical Center	outpatient	387.4	193.7	AmeriHealth Caritas North Carolina	NC Medicaid	136.21	102.69	290.55
Family psychotherapy, not including patient, 50 min	Family Psych w/o Patient 90846	Evaluation & Management	90846	CPT	2388429		Washington Regional Medical Center	outpatient	387.4	193.7	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	136.21	102.69	290.55
Family psychotherapy, not including patient, 50 min	Family Psych w/o Patient 90846	Evaluation & Management	90846	CPT	2388429		Washington Regional Medical Center	outpatient	387.4	193.7	WellCare of North Carolina	North Carolina Medicaid/CHIP	136.21	102.69	290.55
Family psychotherapy, not including patient, 50 min	Family Psych w/o Patient 90846	Evaluation & Management	90846	CPT	2388429		Washington Regional Medical Center	outpatient	387.4	193.7	Healthy Blue / Blue Cross NC	North Carolina Medicaid	136.21	102.69	290.55
Family psychotherapy, not including patient, 50 min	Family Psych w/o Patient 90846	Evaluation & Management	90846	CPT	2388429		Washington Regional Medical Center	outpatient	387.4	193.7	Cigna	North Carolina PPO-PPA Direct	102.69	102.69	290.55
Family psychotherapy, not including patient, 50 min	Family Psych w/o Patient 90846	Evaluation & Management	90846	CPT	2388429		Washington Regional Medical Center	outpatient	387.4	193.7	Original Medicare	Traditional Medicare Fee-for-Service	182.08	102.69	290.55
Family psychotherapy, not including patient, 50 min	Fam Psych w/oPatient PHD 90846	Evaluation & Management	90846	CPT	4299060		Washington Regional Medical Center	outpatient	387.4	193.7	Self-Pay	Discounted Cash		102.69	290.55
Family psychotherapy, not including patient, 50 min	Fam Psych w/oPatient PHD 90846	Evaluation & Management	90846	CPT	4299060		Washington Regional Medical Center	outpatient	387.4	193.7	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	290.55	102.69	290.55
Family psychotherapy, not including patient, 50 min	Fam Psych w/oPatient PHD 90846	Evaluation & Management	90846	CPT	4299060		Washington Regional Medical Center	outpatient	387.4	193.7	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	170.46	102.69	290.55
Family psychotherapy, not including patient, 50 min	Fam Psych w/oPatient PHD 90846	Evaluation & Management	90846	CPT	4299060		Washington Regional Medical Center	outpatient	387.4	193.7	Humana	Medicare Advantage HMO/PPO/PFFS	182.08	102.69	290.55
Family psychotherapy, not including patient, 50 min	Fam Psych w/oPatient PHD 90846	Evaluation & Management	90846	CPT	4299060		Washington Regional Medical Center	outpatient	387.4	193.7	AmeriHealth Caritas North Carolina	NC Medicaid	136.21	102.69	290.55
Family psychotherapy, not including patient, 50 min	Fam Psych w/oPatient PHD 90846	Evaluation & Management	90846	CPT	4299060		Washington Regional Medical Center	outpatient	387.4	193.7	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	136.21	102.69	290.55
Family psychotherapy, not including patient, 50 min	Fam Psych w/oPatient PHD 90846	Evaluation & Management	90846	CPT	4299060		Washington Regional Medical Center	outpatient	387.4	193.7	WellCare of North Carolina	North Carolina Medicaid/CHIP	136.21	102.69	290.55
Family psychotherapy, not including patient, 50 min	Fam Psych w/oPatient PHD 90846	Evaluation & Management	90846	CPT	4299060		Washington Regional Medical Center	outpatient	387.4	193.7	Healthy Blue / Blue Cross NC	North Carolina Medicaid	136.21	102.69	290.55
Family psychotherapy, not including patient, 50 min	Fam Psych w/oPatient PHD 90846	Evaluation & Management	90846	CPT	4299060		Washington Regional Medical Center	outpatient	387.4	193.7	Cigna	North Carolina PPO-PPA Direct	102.69	102.69	290.55
Family psychotherapy, not including patient, 50 min	Fam Psych w/oPatient PHD 90846	Evaluation & Management	90846	CPT	4299060		Washington Regional Medical Center	outpatient	387.4	193.7	Original Medicare	Traditional Medicare Fee-for-Service	182.08	102.69	290.55
Group psychotherapy	Group Psych nt MultiFamG 90853	Evaluation & Management	90853	CPT	10754929		Washington Regional Medical Center	outpatient	123	61.5	Self-Pay	Discounted Cash		34	92.25
Group psychotherapy	Group Psych nt MultiFamG 90853	Evaluation & Management	90853	CPT	10754929		Washington Regional Medical Center	outpatient	123	61.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	92.25	34	92.25
Group psychotherapy	Group Psych nt MultiFamG 90853	Evaluation & Management	90853	CPT	10754929		Washington Regional Medical Center	outpatient	123	61.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	54.12	34	92.25
Group psychotherapy	Group Psych nt MultiFamG 90853	Evaluation & Management	90853	CPT	10754929		Washington Regional Medical Center	outpatient	123	61.5	Humana	Medicare Advantage HMO/PPO/PFFS	57.81	34	92.25
Group psychotherapy	Group Psych nt MultiFamG 90853	Evaluation & Management	90853	CPT	10754929		Washington Regional Medical Center	outpatient	123	61.5	AmeriHealth Caritas North Carolina	NC Medicaid	43.25	34	92.25
Group psychotherapy	Group Psych nt MultiFamG 90853	Evaluation & Management	90853	CPT	10754929		Washington Regional Medical Center	outpatient	123	61.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	43.25	34	92.25
Group psychotherapy	Group Psych nt MultiFamG 90853	Evaluation & Management	90853	CPT	10754929		Washington Regional Medical Center	outpatient	123	61.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	43.25	34	92.25
Group psychotherapy	Group Psych nt MultiFamG 90853	Evaluation & Management	90853	CPT	10754929		Washington Regional Medical Center	outpatient	123	61.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	43.25	34	92.25
Group psychotherapy	Group Psych nt MultiFamG 90853	Evaluation & Management	90853	CPT	10754929		Washington Regional Medical Center	outpatient	123	61.5	Cigna	North Carolina PPO-PPA Direct	34	34	92.25
Group psychotherapy	Group Psych nt MultiFamG 90853	Evaluation & Management	90853	CPT	10754929		Washington Regional Medical Center	outpatient	123	61.5	Original Medicare	Traditional Medicare Fee-for-Service	57.81	34	92.25
Initial new patient preventive medicine evaluation (18-39 years)	INITIAL PREV E&M NEW 18-39	Evaluation & Management	99385	CPT	8001101		Washington Regional Medical Center	outpatient	150	75	Self-Pay	Discounted Cash		52.74	112.5
Initial new patient preventive medicine evaluation (18-39 years)	INITIAL PREV E&M NEW 18-39	Evaluation & Management	99385	CPT	8001101		Washington Regional Medical Center	outpatient	150	75	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	112.5	52.74	112.5
Initial new patient preventive medicine evaluation (18-39 years)	INITIAL PREV E&M NEW 18-39	Evaluation & Management	99385	CPT	8001101		Washington Regional Medical Center	outpatient	150	75	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	66	52.74	112.5
Initial new patient preventive medicine evaluation (18-39 years)	INITIAL PREV E&M NEW 18-39	Evaluation & Management	99385	CPT	8001101		Washington Regional Medical Center	outpatient	150	75	Humana	Medicare Advantage HMO/PPO/PFFS	70.5	52.74	112.5
Initial new patient preventive medicine evaluation (18-39 years)	INITIAL PREV E&M NEW 18-39	Evaluation & Management	99385	CPT	8001101		Washington Regional Medical Center	outpatient	150	75	AmeriHealth Caritas North Carolina	NC Medicaid	52.74	52.74	112.5
Initial new patient preventive medicine evaluation (18-39 years)	INITIAL PREV E&M NEW 18-39	Evaluation & Management	99385	CPT	8001101		Washington Regional Medical Center	outpatient	150	75	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	52.74	52.74	112.5
Initial new patient preventive medicine evaluation (18-39 years)	INITIAL PREV E&M NEW 18-39	Evaluation & Management	99385	CPT	8001101		Washington Regional Medical Center	outpatient	150	75	WellCare of North Carolina	North Carolina Medicaid/CHIP	52.74	52.74	112.5
Initial new patient preventive medicine evaluation (18-39 years)	INITIAL PREV E&M NEW 18-39	Evaluation & Management	99385	CPT	8001101		Washington Regional Medical Center	outpatient	150	75	Healthy Blue / Blue Cross NC	North Carolina Medicaid	52.74	52.74	112.5
Initial new patient preventive medicine evaluation (18-39 years)	INITIAL PREV E&M NEW 18-39	Evaluation & Management	99385	CPT	8001101		Washington Regional Medical Center	outpatient	150	75	Cigna	North Carolina PPO-PPA Direct	88.13	52.74	112.5
Initial new patient preventive medicine evaluation (18-39 years)	INITIAL PREV E&M NEW 18-39	Evaluation & Management	99385	CPT	8001101		Washington Regional Medical Center	outpatient	150	75	Original Medicare	Traditional Medicare Fee-for-Service	70.5	52.74	112.5
Initial new patient preventive medicine evaluation (40-64 years)	Initial new patient preventive medicine evaluation (40-64 years)	Evaluation & Management	99386	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
New patient office or other outpatient visit, typically 30 min	OFFICE/OUTPT VISIT NEW 30MIN- SPEC CLINIC	Evaluation & Management	99203	CPT	7000021		Washington Regional Medical Center	outpatient	491	245.5	Self-Pay	Discounted Cash		76.77	368.25
New patient office or other outpatient visit, typically 30 min	OFFICE/OUTPT VISIT NEW 30MIN- SPEC CLINIC	Evaluation & Management	99203	CPT	7000021		Washington Regional Medical Center	outpatient	491	245.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	368.25	76.77	368.25
New patient office or other outpatient visit, typically 30 min	OFFICE/OUTPT VISIT NEW 30MIN- SPEC CLINIC	Evaluation & Management	99203	CPT	7000021		Washington Regional Medical Center	outpatient	491	245.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	216.04	76.77	368.25
New patient office or other outpatient visit, typically 30 min	OFFICE/OUTPT VISIT NEW 30MIN- SPEC CLINIC	Evaluation & Management	99203	CPT	7000021		Washington Regional Medical Center	outpatient	491	245.5	Humana	Medicare Advantage HMO/PPO/PFFS	230.77	76.77	368.25
New patient office or other outpatient visit, typically 30 min	OFFICE/OUTPT VISIT NEW 30MIN- SPEC CLINIC	Evaluation & Management	99203	CPT	7000021		Washington Regional Medical Center	outpatient	491	245.5	AmeriHealth Caritas North Carolina	NC Medicaid	172.64	76.77	368.25
New patient office or other outpatient visit, typically 30 min	OFFICE/OUTPT VISIT NEW 30MIN- SPEC CLINIC	Evaluation & Management	99203	CPT	7000021		Washington Regional Medical Center	outpatient	491	245.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	172.64	76.77	368.25
New patient office or other outpatient visit, typically 30 min	OFFICE/OUTPT VISIT NEW 30MIN- SPEC CLINIC	Evaluation & Management	99203	CPT	7000021		Washington Regional Medical Center	outpatient	491	245.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	172.64	76.77	368.25
New patient office or other outpatient visit, typically 30 min	OFFICE/OUTPT VISIT NEW 30MIN- SPEC CLINIC	Evaluation & Management	99203	CPT	7000021		Washington Regional Medical Center	outpatient	491	245.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	172.64	76.77	368.25
New patient office or other outpatient visit, typically 30 min	OFFICE/OUTPT VISIT NEW 30MIN- SPEC CLINIC	Evaluation & Management	99203	CPT	7000021		Washington Regional Medical Center	outpatient	491	245.5	Cigna	North Carolina PPO-PPA Direct	76.77	76.77	368.25
New patient office or other outpatient visit, typically 30 min	OFFICE/OUTPT VISIT NEW 30MIN- SPEC CLINIC	Evaluation & Management	99203	CPT	7000021		Washington Regional Medical Center	outpatient	491	245.5	Original Medicare	Traditional Medicare Fee-for-Service	230.77	76.77	368.25
New patient office or other outpatient visit, typically 30 min	OFC NEW LEVEL 3	Evaluation & Management	99203	CPT	8001013		Washington Regional Medical Center	outpatient	491	245.5	Self-Pay	Discounted Cash		76.77	368.25
New patient office or other outpatient visit, typically 30 min	OFC NEW LEVEL 3	Evaluation & Management	99203	CPT	8001013		Washington Regional Medical Center	outpatient	491	245.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	368.25	76.77	368.25
New patient office or other outpatient visit, typically 30 min	OFC NEW LEVEL 3	Evaluation & Management	99203	CPT	8001013		Washington Regional Medical Center	outpatient	491	245.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	216.04	76.77	368.25
New patient office or other outpatient visit, typically 30 min	OFC NEW LEVEL 3	Evaluation & Management	99203	CPT	8001013		Washington Regional Medical Center	outpatient	491	245.5	Humana	Medicare Advantage HMO/PPO/PFFS	230.77	76.77	368.25
New patient office or other outpatient visit, typically 30 min	OFC NEW LEVEL 3	Evaluation & Management	99203	CPT	8001013		Washington Regional Medical Center	outpatient	491	245.5	AmeriHealth Caritas North Carolina	NC Medicaid	172.64	76.77	368.25
New patient office or other outpatient visit, typically 30 min	OFC NEW LEVEL 3	Evaluation & Management	99203	CPT	8001013		Washington Regional Medical Center	outpatient	491	245.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	172.64	76.77	368.25
New patient office or other outpatient visit, typically 30 min	OFC NEW LEVEL 3	Evaluation & Management	99203	CPT	8001013		Washington Regional Medical Center	outpatient	491	245.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	172.64	76.77	368.25
New patient office or other outpatient visit, typically 30 min	OFC NEW LEVEL 3	Evaluation & Management	99203	CPT	8001013		Washington Regional Medical Center	outpatient	491	245.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	172.64	76.77	368.25
New patient office or other outpatient visit, typically 30 min	OFC NEW LEVEL 3	Evaluation & Management	99203	CPT	8001013		Washington Regional Medical Center	outpatient	491	245.5	Cigna	North Carolina PPO-PPA Direct	76.77	76.77	368.25
New patient office or other outpatient visit, typically 30 min	OFC NEW LEVEL 3	Evaluation & Management	99203	CPT	8001013		Washington Regional Medical Center	outpatient	491	245.5	Original Medicare	Traditional Medicare Fee-for-Service	230.77	76.77	368.25
New patient office or other outpatient visit, typically 45 min	OFC NEW LEVEL 4	Evaluation & Management	99204	CPT	8001014		Washington Regional Medical Center	outpatient	598	299	Self-Pay	Discounted Cash		113.95	448.5
New patient office or other outpatient visit, typically 45 min	OFC NEW LEVEL 4	Evaluation & Management	99204	CPT	8001014		Washington Regional Medical Center	outpatient	598	299	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	448.5	113.95	448.5
New patient office or other outpatient visit, typically 45 min	OFC NEW LEVEL 4	Evaluation & Management	99204	CPT	8001014		Washington Regional Medical Center	outpatient	598	299	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	263.12	113.95	448.5
New patient office or other outpatient visit, typically 45 min	OFC NEW LEVEL 4	Evaluation & Management	99204	CPT	8001014		Washington Regional Medical Center	outpatient	598	299	Humana	Medicare Advantage HMO/PPO/PFFS	281.06	113.95	448.5
New patient office or other outpatient visit, typically 45 min	OFC NEW LEVEL 4	Evaluation & Management	99204	CPT	8001014		Washington Regional Medical Center	outpatient	598	299	AmeriHealth Caritas North Carolina	NC Medicaid	210.26	113.95	448.5
New patient office or other outpatient visit, typically 45 min	OFC NEW LEVEL 4	Evaluation & Management	99204	CPT	8001014		Washington Regional Medical Center	outpatient	598	299	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	210.26	113.95	448.5
New patient office or other outpatient visit, typically 45 min	OFC NEW LEVEL 4	Evaluation & Management	99204	CPT	8001014		Washington Regional Medical Center	outpatient	598	299	WellCare of North Carolina	North Carolina Medicaid/CHIP	210.26	113.95	448.5
New patient office or other outpatient visit, typically 45 min	OFC NEW LEVEL 4	Evaluation & Management	99204	CPT	8001014		Washington Regional Medical Center	outpatient	598	299	Healthy Blue / Blue Cross NC	North Carolina Medicaid	210.26	113.95	448.5
New patient office or other outpatient visit, typically 45 min	OFC NEW LEVEL 4	Evaluation & Management	99204	CPT	8001014		Washington Regional Medical Center	outpatient	598	299	Cigna	North Carolina PPO-PPA Direct	113.95	113.95	448.5
New patient office or other outpatient visit, typically 45 min	OFC NEW LEVEL 4	Evaluation & Management	99204	CPT	8001014		Washington Regional Medical Center	outpatient	598	299	Original Medicare	Traditional Medicare Fee-for-Service	281.06	113.95	448.5
New patient office or other outpatient visit, typically 60 min	OFC NEW LEVEL 5	Evaluation & Management	99205	CPT	8001015		Washington Regional Medical Center	outpatient	598	299	Self-Pay	Discounted Cash		151.67	448.5
New patient office or other outpatient visit, typically 60 min	OFC NEW LEVEL 5	Evaluation & Management	99205	CPT	8001015		Washington Regional Medical Center	outpatient	598	299	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	448.5	151.67	448.5
New patient office or other outpatient visit, typically 60 min	OFC NEW LEVEL 5	Evaluation & Management	99205	CPT	8001015		Washington Regional Medical Center	outpatient	598	299	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	263.12	151.67	448.5
New patient office or other outpatient visit, typically 60 min	OFC NEW LEVEL 5	Evaluation & Management	99205	CPT	8001015		Washington Regional Medical Center	outpatient	598	299	Humana	Medicare Advantage HMO/PPO/PFFS	281.06	151.67	448.5
New patient office or other outpatient visit, typically 60 min	OFC NEW LEVEL 5	Evaluation & Management	99205	CPT	8001015		Washington Regional Medical Center	outpatient	598	299	AmeriHealth Caritas North Carolina	NC Medicaid	210.26	151.67	448.5
New patient office or other outpatient visit, typically 60 min	OFC NEW LEVEL 5	Evaluation & Management	99205	CPT	8001015		Washington Regional Medical Center	outpatient	598	299	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	210.26	151.67	448.5
New patient office or other outpatient visit, typically 60 min	OFC NEW LEVEL 5	Evaluation & Management	99205	CPT	8001015		Washington Regional Medical Center	outpatient	598	299	WellCare of North Carolina	North Carolina Medicaid/CHIP	210.26	151.67	448.5
New patient office or other outpatient visit, typically 60 min	OFC NEW LEVEL 5	Evaluation & Management	99205	CPT	8001015		Washington Regional Medical Center	outpatient	598	299	Healthy Blue / Blue Cross NC	North Carolina Medicaid	210.26	151.67	448.5
New patient office or other outpatient visit, typically 60 min	OFC NEW LEVEL 5	Evaluation & Management	99205	CPT	8001015		Washington Regional Medical Center	outpatient	598	299	Cigna	North Carolina PPO-PPA Direct	151.67	151.67	448.5
New patient office or other outpatient visit, typically 60 min	OFC NEW LEVEL 5	Evaluation & Management	99205	CPT	8001015		Washington Regional Medical Center	outpatient	598	299	Original Medicare	Traditional Medicare Fee-for-Service	281.06	151.67	448.5
Patient office consultation, typically 40 min	Patient office consultation, typically 40 min	Evaluation & Management	99243	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Patient office consultation, typically 60 min	Patient office consultation, typically 60 min	Evaluation & Management	99244	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Psychotherapy, 30 min	Psych w/Patient 30 min 90832	Evaluation & Management	90832	CPT	2388420		Washington Regional Medical Center	outpatient	120	60	Self-Pay	Discounted Cash		42.19	90
Psychotherapy, 30 min	Psych w/Patient 30 min 90832	Evaluation & Management	90832	CPT	2388420		Washington Regional Medical Center	outpatient	120	60	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	90	42.19	90
Psychotherapy, 30 min	Psych w/Patient 30 min 90832	Evaluation & Management	90832	CPT	2388420		Washington Regional Medical Center	outpatient	120	60	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	52.8	42.19	90
Psychotherapy, 30 min	Psych w/Patient 30 min 90832	Evaluation & Management	90832	CPT	2388420		Washington Regional Medical Center	outpatient	120	60	Humana	Medicare Advantage HMO/PPO/PFFS	56.4	42.19	90
Psychotherapy, 30 min	Psych w/Patient 30 min 90832	Evaluation & Management	90832	CPT	2388420		Washington Regional Medical Center	outpatient	120	60	AmeriHealth Caritas North Carolina	NC Medicaid	42.19	42.19	90
Psychotherapy, 30 min	Psych w/Patient 30 min 90832	Evaluation & Management	90832	CPT	2388420		Washington Regional Medical Center	outpatient	120	60	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	42.19	42.19	90
Psychotherapy, 30 min	Psych w/Patient 30 min 90832	Evaluation & Management	90832	CPT	2388420		Washington Regional Medical Center	outpatient	120	60	WellCare of North Carolina	North Carolina Medicaid/CHIP	42.19	42.19	90
Psychotherapy, 30 min	Psych w/Patient 30 min 90832	Evaluation & Management	90832	CPT	2388420		Washington Regional Medical Center	outpatient	120	60	Healthy Blue / Blue Cross NC	North Carolina Medicaid	42.19	42.19	90
Psychotherapy, 30 min	Psych w/Patient 30 min 90832	Evaluation & Management	90832	CPT	2388420		Washington Regional Medical Center	outpatient	120	60	Cigna	North Carolina PPO-PPA Direct	58.84	42.19	90
Psychotherapy, 30 min	Psych w/Patient 30 min 90832	Evaluation & Management	90832	CPT	2388420		Washington Regional Medical Center	outpatient	120	60	Original Medicare	Traditional Medicare Fee-for-Service	56.4	42.19	90
Psychotherapy, 45 min	Psychotherapy, 45 min	Evaluation & Management	90834	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Psychotherapy, 60 min	Psychotherapy, 60 min	Evaluation & Management	90837	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
5 HIAA,QN URINE	5 HIAA,QN URINE	Laboratory & Pathology	83497	CPT	3001235		Washington Regional Medical Center	outpatient	70	35	Self-Pay	Discounted Cash		8.41	52.5
5 HIAA,QN URINE	5 HIAA,QN URINE	Laboratory & Pathology	83497	CPT	3001235		Washington Regional Medical Center	outpatient	70	35	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	52.5	8.41	52.5
5 HIAA,QN URINE	5 HIAA,QN URINE	Laboratory & Pathology	83497	CPT	3001235		Washington Regional Medical Center	outpatient	70	35	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	30.8	8.41	52.5
5 HIAA,QN URINE	5 HIAA,QN URINE	Laboratory & Pathology	83497	CPT	3001235		Washington Regional Medical Center	outpatient	70	35	Humana	Medicare Advantage HMO/PPO/PFFS	32.9	8.41	52.5
5 HIAA,QN URINE	5 HIAA,QN URINE	Laboratory & Pathology	83497	CPT	3001235		Washington Regional Medical Center	outpatient	70	35	AmeriHealth Caritas North Carolina	NC Medicaid	23.51	8.41	52.5
5 HIAA,QN URINE	5 HIAA,QN URINE	Laboratory & Pathology	83497	CPT	3001235		Washington Regional Medical Center	outpatient	70	35	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	23.51	8.41	52.5
5 HIAA,QN URINE	5 HIAA,QN URINE	Laboratory & Pathology	83497	CPT	3001235		Washington Regional Medical Center	outpatient	70	35	WellCare of North Carolina	North Carolina Medicaid/CHIP	23.51	8.41	52.5
5 HIAA,QN URINE	5 HIAA,QN URINE	Laboratory & Pathology	83497	CPT	3001235		Washington Regional Medical Center	outpatient	70	35	Healthy Blue / Blue Cross NC	North Carolina Medicaid	23.51	8.41	52.5
5 HIAA,QN URINE	5 HIAA,QN URINE	Laboratory & Pathology	83497	CPT	3001235		Washington Regional Medical Center	outpatient	70	35	Cigna	North Carolina PPO-PPA Direct	8.41	8.41	52.5
5 HIAA,QN URINE	5 HIAA,QN URINE	Laboratory & Pathology	83497	CPT	3001235		Washington Regional Medical Center	outpatient	70	35	Original Medicare	Traditional Medicare Fee-for-Service	32.9	8.41	52.5
ACETAMINOPHEN	ACETAMINOPHEN	Laboratory & Pathology	80143	CPT	3001037		Washington Regional Medical Center	outpatient	170	85	Self-Pay	Discounted Cash		9.29	127.5
ACETAMINOPHEN	ACETAMINOPHEN	Laboratory & Pathology	80143	CPT	3001037		Washington Regional Medical Center	outpatient	170	85	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	127.5	9.29	127.5
ACETAMINOPHEN	ACETAMINOPHEN	Laboratory & Pathology	80143	CPT	3001037		Washington Regional Medical Center	outpatient	170	85	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	74.8	9.29	127.5
ACETAMINOPHEN	ACETAMINOPHEN	Laboratory & Pathology	80143	CPT	3001037		Washington Regional Medical Center	outpatient	170	85	Humana	Medicare Advantage HMO/PPO/PFFS	79.9	9.29	127.5
ACETAMINOPHEN	ACETAMINOPHEN	Laboratory & Pathology	80143	CPT	3001037		Washington Regional Medical Center	outpatient	170	85	AmeriHealth Caritas North Carolina	NC Medicaid	59.77	9.29	127.5
ACETAMINOPHEN	ACETAMINOPHEN	Laboratory & Pathology	80143	CPT	3001037		Washington Regional Medical Center	outpatient	170	85	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	59.77	9.29	127.5
ACETAMINOPHEN	ACETAMINOPHEN	Laboratory & Pathology	80143	CPT	3001037		Washington Regional Medical Center	outpatient	170	85	WellCare of North Carolina	North Carolina Medicaid/CHIP	59.77	9.29	127.5
ACETAMINOPHEN	ACETAMINOPHEN	Laboratory & Pathology	80143	CPT	3001037		Washington Regional Medical Center	outpatient	170	85	Healthy Blue / Blue Cross NC	North Carolina Medicaid	59.77	9.29	127.5
ACETAMINOPHEN	ACETAMINOPHEN	Laboratory & Pathology	80143	CPT	3001037		Washington Regional Medical Center	outpatient	170	85	Cigna	North Carolina PPO-PPA Direct	9.29	9.29	127.5
ACETAMINOPHEN	ACETAMINOPHEN	Laboratory & Pathology	80143	CPT	3001037		Washington Regional Medical Center	outpatient	170	85	Original Medicare	Traditional Medicare Fee-for-Service	79.9	9.29	127.5
AG PAT TESTING INDIRECT QU	AG PAT TESTING INDIRECT QU	Laboratory & Pathology	86885	CPT	3002243		Washington Regional Medical Center	outpatient	48	24	Self-Pay	Discounted Cash		3.68	36
AG PAT TESTING INDIRECT QU	AG PAT TESTING INDIRECT QU	Laboratory & Pathology	86885	CPT	3002243		Washington Regional Medical Center	outpatient	48	24	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	36	3.68	36
AG PAT TESTING INDIRECT QU	AG PAT TESTING INDIRECT QU	Laboratory & Pathology	86885	CPT	3002243		Washington Regional Medical Center	outpatient	48	24	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	21.12	3.68	36
AG PAT TESTING INDIRECT QU	AG PAT TESTING INDIRECT QU	Laboratory & Pathology	86885	CPT	3002243		Washington Regional Medical Center	outpatient	48	24	Humana	Medicare Advantage HMO/PPO/PFFS	22.56	3.68	36
AG PAT TESTING INDIRECT QU	AG PAT TESTING INDIRECT QU	Laboratory & Pathology	86885	CPT	3002243		Washington Regional Medical Center	outpatient	48	24	AmeriHealth Caritas North Carolina	NC Medicaid	10.42	3.68	36
AG PAT TESTING INDIRECT QU	AG PAT TESTING INDIRECT QU	Laboratory & Pathology	86885	CPT	3002243		Washington Regional Medical Center	outpatient	48	24	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	10.42	3.68	36
AG PAT TESTING INDIRECT QU	AG PAT TESTING INDIRECT QU	Laboratory & Pathology	86885	CPT	3002243		Washington Regional Medical Center	outpatient	48	24	WellCare of North Carolina	North Carolina Medicaid/CHIP	10.42	3.68	36
AG PAT TESTING INDIRECT QU	AG PAT TESTING INDIRECT QU	Laboratory & Pathology	86885	CPT	3002243		Washington Regional Medical Center	outpatient	48	24	Healthy Blue / Blue Cross NC	North Carolina Medicaid	10.42	3.68	36
AG PAT TESTING INDIRECT QU	AG PAT TESTING INDIRECT QU	Laboratory & Pathology	86885	CPT	3002243		Washington Regional Medical Center	outpatient	48	24	Cigna	North Carolina PPO-PPA Direct	3.68	3.68	36
AG PAT TESTING INDIRECT QU	AG PAT TESTING INDIRECT QU	Laboratory & Pathology	86885	CPT	3002243		Washington Regional Medical Center	outpatient	48	24	Original Medicare	Traditional Medicare Fee-for-Service	22.56	3.68	36
ALBUMIN SERUM	ALBUMIN SERUM	Laboratory & Pathology	82040	CPT	3001004		Washington Regional Medical Center	outpatient	77	38.5	Self-Pay	Discounted Cash		3.15	57.75
ALBUMIN SERUM	ALBUMIN SERUM	Laboratory & Pathology	82040	CPT	3001004		Washington Regional Medical Center	outpatient	77	38.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	57.75	3.15	57.75
ALBUMIN SERUM	ALBUMIN SERUM	Laboratory & Pathology	82040	CPT	3001004		Washington Regional Medical Center	outpatient	77	38.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	33.88	3.15	57.75
ALBUMIN SERUM	ALBUMIN SERUM	Laboratory & Pathology	82040	CPT	3001004		Washington Regional Medical Center	outpatient	77	38.5	Humana	Medicare Advantage HMO/PPO/PFFS	36.19	3.15	57.75
ALBUMIN SERUM	ALBUMIN SERUM	Laboratory & Pathology	82040	CPT	3001004		Washington Regional Medical Center	outpatient	77	38.5	AmeriHealth Caritas North Carolina	NC Medicaid	9.03	3.15	57.75
ALBUMIN SERUM	ALBUMIN SERUM	Laboratory & Pathology	82040	CPT	3001004		Washington Regional Medical Center	outpatient	77	38.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	9.03	3.15	57.75
ALBUMIN SERUM	ALBUMIN SERUM	Laboratory & Pathology	82040	CPT	3001004		Washington Regional Medical Center	outpatient	77	38.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	9.03	3.15	57.75
ALBUMIN SERUM	ALBUMIN SERUM	Laboratory & Pathology	82040	CPT	3001004		Washington Regional Medical Center	outpatient	77	38.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	9.03	3.15	57.75
ALBUMIN SERUM	ALBUMIN SERUM	Laboratory & Pathology	82040	CPT	3001004		Washington Regional Medical Center	outpatient	77	38.5	Cigna	North Carolina PPO-PPA Direct	3.15	3.15	57.75
ALBUMIN SERUM	ALBUMIN SERUM	Laboratory & Pathology	82040	CPT	3001004		Washington Regional Medical Center	outpatient	77	38.5	Original Medicare	Traditional Medicare Fee-for-Service	36.19	3.15	57.75
ALUMINUM	ALUMINUM	Laboratory & Pathology	82108	CPT	3001587		Washington Regional Medical Center	outpatient	55	27.5	Self-Pay	Discounted Cash		16.48	46.48
ALUMINUM	ALUMINUM	Laboratory & Pathology	82108	CPT	3001587		Washington Regional Medical Center	outpatient	55	27.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	41.25	16.48	46.48
ALUMINUM	ALUMINUM	Laboratory & Pathology	82108	CPT	3001587		Washington Regional Medical Center	outpatient	55	27.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	24.2	16.48	46.48
ALUMINUM	ALUMINUM	Laboratory & Pathology	82108	CPT	3001587		Washington Regional Medical Center	outpatient	55	27.5	Humana	Medicare Advantage HMO/PPO/PFFS	25.85	16.48	46.48
ALUMINUM	ALUMINUM	Laboratory & Pathology	82108	CPT	3001587		Washington Regional Medical Center	outpatient	55	27.5	AmeriHealth Caritas North Carolina	NC Medicaid	46.48	16.48	46.48
ALUMINUM	ALUMINUM	Laboratory & Pathology	82108	CPT	3001587		Washington Regional Medical Center	outpatient	55	27.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	46.48	16.48	46.48
ALUMINUM	ALUMINUM	Laboratory & Pathology	82108	CPT	3001587		Washington Regional Medical Center	outpatient	55	27.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	46.48	16.48	46.48
ALUMINUM	ALUMINUM	Laboratory & Pathology	82108	CPT	3001587		Washington Regional Medical Center	outpatient	55	27.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	46.48	16.48	46.48
ALUMINUM	ALUMINUM	Laboratory & Pathology	82108	CPT	3001587		Washington Regional Medical Center	outpatient	55	27.5	Cigna	North Carolina PPO-PPA Direct	16.48	16.48	46.48
ALUMINUM	ALUMINUM	Laboratory & Pathology	82108	CPT	3001587		Washington Regional Medical Center	outpatient	55	27.5	Original Medicare	Traditional Medicare Fee-for-Service	25.85	16.48	46.48
AMPHETAMINES; 3 OR 4	AMPHETAMINES; 3 OR 4	Laboratory & Pathology	80325	CPT	3000099		Washington Regional Medical Center	outpatient	231	115.5	Self-Pay	Discounted Cash		81.22	173.25
AMPHETAMINES; 3 OR 4	AMPHETAMINES; 3 OR 4	Laboratory & Pathology	80325	CPT	3000099		Washington Regional Medical Center	outpatient	231	115.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	173.25	81.22	173.25
AMPHETAMINES; 3 OR 4	AMPHETAMINES; 3 OR 4	Laboratory & Pathology	80325	CPT	3000099		Washington Regional Medical Center	outpatient	231	115.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	101.64	81.22	173.25
AMPHETAMINES; 3 OR 4	AMPHETAMINES; 3 OR 4	Laboratory & Pathology	80325	CPT	3000099		Washington Regional Medical Center	outpatient	231	115.5	Humana	Medicare Advantage HMO/PPO/PFFS	108.57	81.22	173.25
AMPHETAMINES; 3 OR 4	AMPHETAMINES; 3 OR 4	Laboratory & Pathology	80325	CPT	3000099		Washington Regional Medical Center	outpatient	231	115.5	AmeriHealth Caritas North Carolina	NC Medicaid	81.22	81.22	173.25
AMPHETAMINES; 3 OR 4	AMPHETAMINES; 3 OR 4	Laboratory & Pathology	80325	CPT	3000099		Washington Regional Medical Center	outpatient	231	115.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	81.22	81.22	173.25
AMPHETAMINES; 3 OR 4	AMPHETAMINES; 3 OR 4	Laboratory & Pathology	80325	CPT	3000099		Washington Regional Medical Center	outpatient	231	115.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	81.22	81.22	173.25
AMPHETAMINES; 3 OR 4	AMPHETAMINES; 3 OR 4	Laboratory & Pathology	80325	CPT	3000099		Washington Regional Medical Center	outpatient	231	115.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	81.22	81.22	173.25
AMPHETAMINES; 3 OR 4	AMPHETAMINES; 3 OR 4	Laboratory & Pathology	80325	CPT	3000099		Washington Regional Medical Center	outpatient	231	115.5	Original Medicare	Traditional Medicare Fee-for-Service	108.57	81.22	173.25
ANA CASCADING ANTIB	ANA CASCADING ANTIB	Laboratory & Pathology	86038	CPT	3001134		Washington Regional Medical Center	outpatient	117	58.5	Self-Pay	Discounted Cash		7.89	87.75
ANA CASCADING ANTIB	ANA CASCADING ANTIB	Laboratory & Pathology	86038	CPT	3001134		Washington Regional Medical Center	outpatient	117	58.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	87.75	7.89	87.75
ANA CASCADING ANTIB	ANA CASCADING ANTIB	Laboratory & Pathology	86038	CPT	3001134		Washington Regional Medical Center	outpatient	117	58.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	51.48	7.89	87.75
ANA CASCADING ANTIB	ANA CASCADING ANTIB	Laboratory & Pathology	86038	CPT	3001134		Washington Regional Medical Center	outpatient	117	58.5	Humana	Medicare Advantage HMO/PPO/PFFS	54.99	7.89	87.75
ANA CASCADING ANTIB	ANA CASCADING ANTIB	Laboratory & Pathology	86038	CPT	3001134		Washington Regional Medical Center	outpatient	117	58.5	AmeriHealth Caritas North Carolina	NC Medicaid	22.04	7.89	87.75
ANA CASCADING ANTIB	ANA CASCADING ANTIB	Laboratory & Pathology	86038	CPT	3001134		Washington Regional Medical Center	outpatient	117	58.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	22.04	7.89	87.75
ANA CASCADING ANTIB	ANA CASCADING ANTIB	Laboratory & Pathology	86038	CPT	3001134		Washington Regional Medical Center	outpatient	117	58.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	22.04	7.89	87.75
ANA CASCADING ANTIB	ANA CASCADING ANTIB	Laboratory & Pathology	86038	CPT	3001134		Washington Regional Medical Center	outpatient	117	58.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	22.04	7.89	87.75
ANA CASCADING ANTIB	ANA CASCADING ANTIB	Laboratory & Pathology	86038	CPT	3001134		Washington Regional Medical Center	outpatient	117	58.5	Cigna	North Carolina PPO-PPA Direct	7.89	7.89	87.75
ANA CASCADING ANTIB	ANA CASCADING ANTIB	Laboratory & Pathology	86038	CPT	3001134		Washington Regional Medical Center	outpatient	117	58.5	Original Medicare	Traditional Medicare Fee-for-Service	54.99	7.89	87.75
ANGIOTEN I CONVERT ENZYME	ANGIOTEN I CONVERT ENZYME	Laboratory & Pathology	82164	CPT	3001123		Washington Regional Medical Center	outpatient	139	69.5	Self-Pay	Discounted Cash		9.46	104.25
ANGIOTEN I CONVERT ENZYME	ANGIOTEN I CONVERT ENZYME	Laboratory & Pathology	82164	CPT	3001123		Washington Regional Medical Center	outpatient	139	69.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	104.25	9.46	104.25
ANGIOTEN I CONVERT ENZYME	ANGIOTEN I CONVERT ENZYME	Laboratory & Pathology	82164	CPT	3001123		Washington Regional Medical Center	outpatient	139	69.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	61.16	9.46	104.25
ANGIOTEN I CONVERT ENZYME	ANGIOTEN I CONVERT ENZYME	Laboratory & Pathology	82164	CPT	3001123		Washington Regional Medical Center	outpatient	139	69.5	Humana	Medicare Advantage HMO/PPO/PFFS	65.33	9.46	104.25
ANGIOTEN I CONVERT ENZYME	ANGIOTEN I CONVERT ENZYME	Laboratory & Pathology	82164	CPT	3001123		Washington Regional Medical Center	outpatient	139	69.5	AmeriHealth Caritas North Carolina	NC Medicaid	26.61	9.46	104.25
ANGIOTEN I CONVERT ENZYME	ANGIOTEN I CONVERT ENZYME	Laboratory & Pathology	82164	CPT	3001123		Washington Regional Medical Center	outpatient	139	69.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	26.61	9.46	104.25
ANGIOTEN I CONVERT ENZYME	ANGIOTEN I CONVERT ENZYME	Laboratory & Pathology	82164	CPT	3001123		Washington Regional Medical Center	outpatient	139	69.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	26.61	9.46	104.25
ANGIOTEN I CONVERT ENZYME	ANGIOTEN I CONVERT ENZYME	Laboratory & Pathology	82164	CPT	3001123		Washington Regional Medical Center	outpatient	139	69.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	26.61	9.46	104.25
ANGIOTEN I CONVERT ENZYME	ANGIOTEN I CONVERT ENZYME	Laboratory & Pathology	82164	CPT	3001123		Washington Regional Medical Center	outpatient	139	69.5	Cigna	North Carolina PPO-PPA Direct	9.46	9.46	104.25
ANGIOTEN I CONVERT ENZYME	ANGIOTEN I CONVERT ENZYME	Laboratory & Pathology	82164	CPT	3001123		Washington Regional Medical Center	outpatient	139	69.5	Original Medicare	Traditional Medicare Fee-for-Service	65.33	9.46	104.25
ANTIDEPRES, CYCLICALS; 3-5	ANTIDEPRES, CYCLICALS; 3-5	Laboratory & Pathology	80336	CPT	3020029		Washington Regional Medical Center	outpatient	370	185	Self-Pay	Discounted Cash		130.09	277.5
ANTIDEPRES, CYCLICALS; 3-5	ANTIDEPRES, CYCLICALS; 3-5	Laboratory & Pathology	80336	CPT	3020029		Washington Regional Medical Center	outpatient	370	185	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	277.5	130.09	277.5
ANTIDEPRES, CYCLICALS; 3-5	ANTIDEPRES, CYCLICALS; 3-5	Laboratory & Pathology	80336	CPT	3020029		Washington Regional Medical Center	outpatient	370	185	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	162.8	130.09	277.5
ANTIDEPRES, CYCLICALS; 3-5	ANTIDEPRES, CYCLICALS; 3-5	Laboratory & Pathology	80336	CPT	3020029		Washington Regional Medical Center	outpatient	370	185	Humana	Medicare Advantage HMO/PPO/PFFS	173.9	130.09	277.5
ANTIDEPRES, CYCLICALS; 3-5	ANTIDEPRES, CYCLICALS; 3-5	Laboratory & Pathology	80336	CPT	3020029		Washington Regional Medical Center	outpatient	370	185	AmeriHealth Caritas North Carolina	NC Medicaid	130.09	130.09	277.5
ANTIDEPRES, CYCLICALS; 3-5	ANTIDEPRES, CYCLICALS; 3-5	Laboratory & Pathology	80336	CPT	3020029		Washington Regional Medical Center	outpatient	370	185	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	130.09	130.09	277.5
ANTIDEPRES, CYCLICALS; 3-5	ANTIDEPRES, CYCLICALS; 3-5	Laboratory & Pathology	80336	CPT	3020029		Washington Regional Medical Center	outpatient	370	185	WellCare of North Carolina	North Carolina Medicaid/CHIP	130.09	130.09	277.5
ANTIDEPRES, CYCLICALS; 3-5	ANTIDEPRES, CYCLICALS; 3-5	Laboratory & Pathology	80336	CPT	3020029		Washington Regional Medical Center	outpatient	370	185	Healthy Blue / Blue Cross NC	North Carolina Medicaid	130.09	130.09	277.5
ANTIDEPRES, CYCLICALS; 3-5	ANTIDEPRES, CYCLICALS; 3-5	Laboratory & Pathology	80336	CPT	3020029		Washington Regional Medical Center	outpatient	370	185	Original Medicare	Traditional Medicare Fee-for-Service	173.9	130.09	277.5
ANTITHROMBIN 3 AG	ANTITHROMBIN 3 AG	Laboratory & Pathology	85301	CPT	3001620		Washington Regional Medical Center	outpatient	43	21.5	Self-Pay	Discounted Cash		7.01	32.25
ANTITHROMBIN 3 AG	ANTITHROMBIN 3 AG	Laboratory & Pathology	85301	CPT	3001620		Washington Regional Medical Center	outpatient	43	21.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	32.25	7.01	32.25
ANTITHROMBIN 3 AG	ANTITHROMBIN 3 AG	Laboratory & Pathology	85301	CPT	3001620		Washington Regional Medical Center	outpatient	43	21.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	18.92	7.01	32.25
ANTITHROMBIN 3 AG	ANTITHROMBIN 3 AG	Laboratory & Pathology	85301	CPT	3001620		Washington Regional Medical Center	outpatient	43	21.5	Humana	Medicare Advantage HMO/PPO/PFFS	20.21	7.01	32.25
ANTITHROMBIN 3 AG	ANTITHROMBIN 3 AG	Laboratory & Pathology	85301	CPT	3001620		Washington Regional Medical Center	outpatient	43	21.5	AmeriHealth Caritas North Carolina	NC Medicaid	19.73	7.01	32.25
ANTITHROMBIN 3 AG	ANTITHROMBIN 3 AG	Laboratory & Pathology	85301	CPT	3001620		Washington Regional Medical Center	outpatient	43	21.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	19.73	7.01	32.25
ANTITHROMBIN 3 AG	ANTITHROMBIN 3 AG	Laboratory & Pathology	85301	CPT	3001620		Washington Regional Medical Center	outpatient	43	21.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	19.73	7.01	32.25
ANTITHROMBIN 3 AG	ANTITHROMBIN 3 AG	Laboratory & Pathology	85301	CPT	3001620		Washington Regional Medical Center	outpatient	43	21.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	19.73	7.01	32.25
ANTITHROMBIN 3 AG	ANTITHROMBIN 3 AG	Laboratory & Pathology	85301	CPT	3001620		Washington Regional Medical Center	outpatient	43	21.5	Cigna	North Carolina PPO-PPA Direct	7.01	7.01	32.25
ANTITHROMBIN 3 AG	ANTITHROMBIN 3 AG	Laboratory & Pathology	85301	CPT	3001620		Washington Regional Medical Center	outpatient	43	21.5	Original Medicare	Traditional Medicare Fee-for-Service	20.21	7.01	32.25
ANTITHYROGLOBULIN ANTIB	ANTITHYROGLOBULIN ANTIB	Laboratory & Pathology	86800	CPT	3001133		Washington Regional Medical Center	outpatient	90	45	Self-Pay	Discounted Cash		10.34	67.5
ANTITHYROGLOBULIN ANTIB	ANTITHYROGLOBULIN ANTIB	Laboratory & Pathology	86800	CPT	3001133		Washington Regional Medical Center	outpatient	90	45	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	67.5	10.34	67.5
ANTITHYROGLOBULIN ANTIB	ANTITHYROGLOBULIN ANTIB	Laboratory & Pathology	86800	CPT	3001133		Washington Regional Medical Center	outpatient	90	45	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	39.6	10.34	67.5
ANTITHYROGLOBULIN ANTIB	ANTITHYROGLOBULIN ANTIB	Laboratory & Pathology	86800	CPT	3001133		Washington Regional Medical Center	outpatient	90	45	Humana	Medicare Advantage HMO/PPO/PFFS	42.3	10.34	67.5
ANTITHYROGLOBULIN ANTIB	ANTITHYROGLOBULIN ANTIB	Laboratory & Pathology	86800	CPT	3001133		Washington Regional Medical Center	outpatient	90	45	AmeriHealth Caritas North Carolina	NC Medicaid	29.01	10.34	67.5
ANTITHYROGLOBULIN ANTIB	ANTITHYROGLOBULIN ANTIB	Laboratory & Pathology	86800	CPT	3001133		Washington Regional Medical Center	outpatient	90	45	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	29.01	10.34	67.5
ANTITHYROGLOBULIN ANTIB	ANTITHYROGLOBULIN ANTIB	Laboratory & Pathology	86800	CPT	3001133		Washington Regional Medical Center	outpatient	90	45	WellCare of North Carolina	North Carolina Medicaid/CHIP	29.01	10.34	67.5
ANTITHYROGLOBULIN ANTIB	ANTITHYROGLOBULIN ANTIB	Laboratory & Pathology	86800	CPT	3001133		Washington Regional Medical Center	outpatient	90	45	Healthy Blue / Blue Cross NC	North Carolina Medicaid	29.01	10.34	67.5
ANTITHYROGLOBULIN ANTIB	ANTITHYROGLOBULIN ANTIB	Laboratory & Pathology	86800	CPT	3001133		Washington Regional Medical Center	outpatient	90	45	Cigna	North Carolina PPO-PPA Direct	10.34	10.34	67.5
ANTITHYROGLOBULIN ANTIB	ANTITHYROGLOBULIN ANTIB	Laboratory & Pathology	86800	CPT	3001133		Washington Regional Medical Center	outpatient	90	45	Original Medicare	Traditional Medicare Fee-for-Service	42.3	10.34	67.5
ASPERGILUS IGM	ASPERGILUS IGM	Laboratory & Pathology	86606	CPT	3002034		Washington Regional Medical Center	outpatient	88	44	Self-Pay	Discounted Cash		9.64	66
ASPERGILUS IGM	ASPERGILUS IGM	Laboratory & Pathology	86606	CPT	3002034		Washington Regional Medical Center	outpatient	88	44	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	66	9.64	66
ASPERGILUS IGM	ASPERGILUS IGM	Laboratory & Pathology	86606	CPT	3002034		Washington Regional Medical Center	outpatient	88	44	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	38.72	9.64	66
ASPERGILUS IGM	ASPERGILUS IGM	Laboratory & Pathology	86606	CPT	3002034		Washington Regional Medical Center	outpatient	88	44	Humana	Medicare Advantage HMO/PPO/PFFS	41.36	9.64	66
ASPERGILUS IGM	ASPERGILUS IGM	Laboratory & Pathology	86606	CPT	3002034		Washington Regional Medical Center	outpatient	88	44	AmeriHealth Caritas North Carolina	NC Medicaid	23.26	9.64	66
ASPERGILUS IGM	ASPERGILUS IGM	Laboratory & Pathology	86606	CPT	3002034		Washington Regional Medical Center	outpatient	88	44	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	23.26	9.64	66
ASPERGILUS IGM	ASPERGILUS IGM	Laboratory & Pathology	86606	CPT	3002034		Washington Regional Medical Center	outpatient	88	44	WellCare of North Carolina	North Carolina Medicaid/CHIP	23.26	9.64	66
ASPERGILUS IGM	ASPERGILUS IGM	Laboratory & Pathology	86606	CPT	3002034		Washington Regional Medical Center	outpatient	88	44	Healthy Blue / Blue Cross NC	North Carolina Medicaid	23.26	9.64	66
ASPERGILUS IGM	ASPERGILUS IGM	Laboratory & Pathology	86606	CPT	3002034		Washington Regional Medical Center	outpatient	88	44	Cigna	North Carolina PPO-PPA Direct	9.64	9.64	66
ASPERGILUS IGM	ASPERGILUS IGM	Laboratory & Pathology	86606	CPT	3002034		Washington Regional Medical Center	outpatient	88	44	Original Medicare	Traditional Medicare Fee-for-Service	41.36	9.64	66
Automated urinalysis test	UA DIPSTICK NON-AUTO W/O MICRO	Laboratory & Pathology	81002	CPT	3001513		Washington Regional Medical Center	outpatient	32	16	Self-Pay	Discounted Cash		2.52	24
Automated urinalysis test	UA DIPSTICK NON-AUTO W/O MICRO	Laboratory & Pathology	81002	CPT	3001513		Washington Regional Medical Center	outpatient	32	16	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	24	2.52	24
Automated urinalysis test	UA DIPSTICK NON-AUTO W/O MICRO	Laboratory & Pathology	81002	CPT	3001513		Washington Regional Medical Center	outpatient	32	16	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	14.08	2.52	24
Automated urinalysis test	UA DIPSTICK NON-AUTO W/O MICRO	Laboratory & Pathology	81002	CPT	3001513		Washington Regional Medical Center	outpatient	32	16	Humana	Medicare Advantage HMO/PPO/PFFS	15.04	2.52	24
Automated urinalysis test	UA DIPSTICK NON-AUTO W/O MICRO	Laboratory & Pathology	81002	CPT	3001513		Washington Regional Medical Center	outpatient	32	16	AmeriHealth Caritas North Carolina	NC Medicaid	4.67	2.52	24
Automated urinalysis test	UA DIPSTICK NON-AUTO W/O MICRO	Laboratory & Pathology	81002	CPT	3001513		Washington Regional Medical Center	outpatient	32	16	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	4.67	2.52	24
Automated urinalysis test	UA DIPSTICK NON-AUTO W/O MICRO	Laboratory & Pathology	81002	CPT	3001513		Washington Regional Medical Center	outpatient	32	16	WellCare of North Carolina	North Carolina Medicaid/CHIP	4.67	2.52	24
Automated urinalysis test	UA DIPSTICK NON-AUTO W/O MICRO	Laboratory & Pathology	81002	CPT	3001513		Washington Regional Medical Center	outpatient	32	16	Healthy Blue / Blue Cross NC	North Carolina Medicaid	4.67	2.52	24
Automated urinalysis test	UA DIPSTICK NON-AUTO W/O MICRO	Laboratory & Pathology	81002	CPT	3001513		Washington Regional Medical Center	outpatient	32	16	Cigna	North Carolina PPO-PPA Direct	2.52	2.52	24
Automated urinalysis test	UA DIPSTICK NON-AUTO W/O MICRO	Laboratory & Pathology	81002	CPT	3001513		Washington Regional Medical Center	outpatient	32	16	Original Medicare	Traditional Medicare Fee-for-Service	15.04	2.52	24
Automated urinalysis test	UA DIPSTICK NON-AUTO W/O MICRO	Laboratory & Pathology	81002	CPT	8001001		Washington Regional Medical Center	outpatient	32	16	Self-Pay	Discounted Cash		2.52	24
Automated urinalysis test	UA DIPSTICK NON-AUTO W/O MICRO	Laboratory & Pathology	81002	CPT	8001001		Washington Regional Medical Center	outpatient	32	16	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	24	2.52	24
Automated urinalysis test	UA DIPSTICK NON-AUTO W/O MICRO	Laboratory & Pathology	81002	CPT	8001001		Washington Regional Medical Center	outpatient	32	16	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	14.08	2.52	24
Automated urinalysis test	UA DIPSTICK NON-AUTO W/O MICRO	Laboratory & Pathology	81002	CPT	8001001		Washington Regional Medical Center	outpatient	32	16	Humana	Medicare Advantage HMO/PPO/PFFS	15.04	2.52	24
Automated urinalysis test	UA DIPSTICK NON-AUTO W/O MICRO	Laboratory & Pathology	81002	CPT	8001001		Washington Regional Medical Center	outpatient	32	16	AmeriHealth Caritas North Carolina	NC Medicaid	4.67	2.52	24
Automated urinalysis test	UA DIPSTICK NON-AUTO W/O MICRO	Laboratory & Pathology	81002	CPT	8001001		Washington Regional Medical Center	outpatient	32	16	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	4.67	2.52	24
Automated urinalysis test	UA DIPSTICK NON-AUTO W/O MICRO	Laboratory & Pathology	81002	CPT	8001001		Washington Regional Medical Center	outpatient	32	16	WellCare of North Carolina	North Carolina Medicaid/CHIP	4.67	2.52	24
Automated urinalysis test	UA DIPSTICK NON-AUTO W/O MICRO	Laboratory & Pathology	81002	CPT	8001001		Washington Regional Medical Center	outpatient	32	16	Healthy Blue / Blue Cross NC	North Carolina Medicaid	4.67	2.52	24
Automated urinalysis test	UA DIPSTICK NON-AUTO W/O MICRO	Laboratory & Pathology	81002	CPT	8001001		Washington Regional Medical Center	outpatient	32	16	Cigna	North Carolina PPO-PPA Direct	2.52	2.52	24
Automated urinalysis test	UA DIPSTICK NON-AUTO W/O MICRO	Laboratory & Pathology	81002	CPT	8001001		Washington Regional Medical Center	outpatient	32	16	Original Medicare	Traditional Medicare Fee-for-Service	15.04	2.52	24
Automated urinalysis test	UA DIPSTICK AUTO W/O MICRO	Laboratory & Pathology	81003	CPT	3001628		Washington Regional Medical Center	outpatient	137	68.5	Self-Pay	Discounted Cash		2.24	102.75
Automated urinalysis test	UA DIPSTICK AUTO W/O MICRO	Laboratory & Pathology	81003	CPT	3001628		Washington Regional Medical Center	outpatient	137	68.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	102.75	2.24	102.75
Automated urinalysis test	UA DIPSTICK AUTO W/O MICRO	Laboratory & Pathology	81003	CPT	3001628		Washington Regional Medical Center	outpatient	137	68.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	60.28	2.24	102.75
Automated urinalysis test	UA DIPSTICK AUTO W/O MICRO	Laboratory & Pathology	81003	CPT	3001628		Washington Regional Medical Center	outpatient	137	68.5	Humana	Medicare Advantage HMO/PPO/PFFS	64.39	2.24	102.75
Automated urinalysis test	UA DIPSTICK AUTO W/O MICRO	Laboratory & Pathology	81003	CPT	3001628		Washington Regional Medical Center	outpatient	137	68.5	AmeriHealth Caritas North Carolina	NC Medicaid	4.1	2.24	102.75
Automated urinalysis test	UA DIPSTICK AUTO W/O MICRO	Laboratory & Pathology	81003	CPT	3001628		Washington Regional Medical Center	outpatient	137	68.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	4.1	2.24	102.75
Automated urinalysis test	UA DIPSTICK AUTO W/O MICRO	Laboratory & Pathology	81003	CPT	3001628		Washington Regional Medical Center	outpatient	137	68.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	4.1	2.24	102.75
Automated urinalysis test	UA DIPSTICK AUTO W/O MICRO	Laboratory & Pathology	81003	CPT	3001628		Washington Regional Medical Center	outpatient	137	68.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	4.1	2.24	102.75
Automated urinalysis test	UA DIPSTICK AUTO W/O MICRO	Laboratory & Pathology	81003	CPT	3001628		Washington Regional Medical Center	outpatient	137	68.5	Cigna	North Carolina PPO-PPA Direct	2.24	2.24	102.75
Automated urinalysis test	UA DIPSTICK AUTO W/O MICRO	Laboratory & Pathology	81003	CPT	3001628		Washington Regional Medical Center	outpatient	137	68.5	Original Medicare	Traditional Medicare Fee-for-Service	64.39	2.24	102.75
Basic metabolic panel	BASIC METAB PANEL	Laboratory & Pathology	80048	CPT	3001073		Washington Regional Medical Center	outpatient	67	33.5	Self-Pay	Discounted Cash		8.69	50.25
Basic metabolic panel	BASIC METAB PANEL	Laboratory & Pathology	80048	CPT	3001073		Washington Regional Medical Center	outpatient	67	33.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	50.25	8.69	50.25
Basic metabolic panel	BASIC METAB PANEL	Laboratory & Pathology	80048	CPT	3001073		Washington Regional Medical Center	outpatient	67	33.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	29.48	8.69	50.25
Basic metabolic panel	BASIC METAB PANEL	Laboratory & Pathology	80048	CPT	3001073		Washington Regional Medical Center	outpatient	67	33.5	Humana	Medicare Advantage HMO/PPO/PFFS	31.49	8.69	50.25
Basic metabolic panel	BASIC METAB PANEL	Laboratory & Pathology	80048	CPT	3001073		Washington Regional Medical Center	outpatient	67	33.5	AmeriHealth Caritas North Carolina	NC Medicaid	14.62	8.69	50.25
Basic metabolic panel	BASIC METAB PANEL	Laboratory & Pathology	80048	CPT	3001073		Washington Regional Medical Center	outpatient	67	33.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	14.62	8.69	50.25
Basic metabolic panel	BASIC METAB PANEL	Laboratory & Pathology	80048	CPT	3001073		Washington Regional Medical Center	outpatient	67	33.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	14.62	8.69	50.25
Basic metabolic panel	BASIC METAB PANEL	Laboratory & Pathology	80048	CPT	3001073		Washington Regional Medical Center	outpatient	67	33.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	14.62	8.69	50.25
Basic metabolic panel	BASIC METAB PANEL	Laboratory & Pathology	80048	CPT	3001073		Washington Regional Medical Center	outpatient	67	33.5	Cigna	North Carolina PPO-PPA Direct	8.69	8.69	50.25
Basic metabolic panel	BASIC METAB PANEL	Laboratory & Pathology	80048	CPT	3001073		Washington Regional Medical Center	outpatient	67	33.5	Original Medicare	Traditional Medicare Fee-for-Service	31.49	8.69	50.25
BENZODIAZEPINES; 1-12	BENZODIAZEPINES; 1-12	Laboratory & Pathology	80346	CPT	3000021		Washington Regional Medical Center	outpatient	170	85	Self-Pay	Discounted Cash		59.77	127.5
BENZODIAZEPINES; 1-12	BENZODIAZEPINES; 1-12	Laboratory & Pathology	80346	CPT	3000021		Washington Regional Medical Center	outpatient	170	85	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	127.5	59.77	127.5
BENZODIAZEPINES; 1-12	BENZODIAZEPINES; 1-12	Laboratory & Pathology	80346	CPT	3000021		Washington Regional Medical Center	outpatient	170	85	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	74.8	59.77	127.5
BENZODIAZEPINES; 1-12	BENZODIAZEPINES; 1-12	Laboratory & Pathology	80346	CPT	3000021		Washington Regional Medical Center	outpatient	170	85	Humana	Medicare Advantage HMO/PPO/PFFS	79.9	59.77	127.5
BENZODIAZEPINES; 1-12	BENZODIAZEPINES; 1-12	Laboratory & Pathology	80346	CPT	3000021		Washington Regional Medical Center	outpatient	170	85	AmeriHealth Caritas North Carolina	NC Medicaid	59.77	59.77	127.5
BENZODIAZEPINES; 1-12	BENZODIAZEPINES; 1-12	Laboratory & Pathology	80346	CPT	3000021		Washington Regional Medical Center	outpatient	170	85	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	59.77	59.77	127.5
BENZODIAZEPINES; 1-12	BENZODIAZEPINES; 1-12	Laboratory & Pathology	80346	CPT	3000021		Washington Regional Medical Center	outpatient	170	85	WellCare of North Carolina	North Carolina Medicaid/CHIP	59.77	59.77	127.5
BENZODIAZEPINES; 1-12	BENZODIAZEPINES; 1-12	Laboratory & Pathology	80346	CPT	3000021		Washington Regional Medical Center	outpatient	170	85	Healthy Blue / Blue Cross NC	North Carolina Medicaid	59.77	59.77	127.5
BENZODIAZEPINES; 1-12	BENZODIAZEPINES; 1-12	Laboratory & Pathology	80346	CPT	3000021		Washington Regional Medical Center	outpatient	170	85	Original Medicare	Traditional Medicare Fee-for-Service	79.9	59.77	127.5
BETA-HCG QUANT SERUM	BETA-HCG QUANT SERUM	Laboratory & Pathology	84702	CPT	3001366		Washington Regional Medical Center	outpatient	205	102.5	Self-Pay	Discounted Cash		9.64	153.75
BETA-HCG QUANT SERUM	BETA-HCG QUANT SERUM	Laboratory & Pathology	84702	CPT	3001366		Washington Regional Medical Center	outpatient	205	102.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	153.75	9.64	153.75
BETA-HCG QUANT SERUM	BETA-HCG QUANT SERUM	Laboratory & Pathology	84702	CPT	3001366		Washington Regional Medical Center	outpatient	205	102.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	90.2	9.64	153.75
BETA-HCG QUANT SERUM	BETA-HCG QUANT SERUM	Laboratory & Pathology	84702	CPT	3001366		Washington Regional Medical Center	outpatient	205	102.5	Humana	Medicare Advantage HMO/PPO/PFFS	96.35	9.64	153.75
BETA-HCG QUANT SERUM	BETA-HCG QUANT SERUM	Laboratory & Pathology	84702	CPT	3001366		Washington Regional Medical Center	outpatient	205	102.5	AmeriHealth Caritas North Carolina	NC Medicaid	15.96	9.64	153.75
BETA-HCG QUANT SERUM	BETA-HCG QUANT SERUM	Laboratory & Pathology	84702	CPT	3001366		Washington Regional Medical Center	outpatient	205	102.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	15.96	9.64	153.75
BETA-HCG QUANT SERUM	BETA-HCG QUANT SERUM	Laboratory & Pathology	84702	CPT	3001366		Washington Regional Medical Center	outpatient	205	102.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	15.96	9.64	153.75
BETA-HCG QUANT SERUM	BETA-HCG QUANT SERUM	Laboratory & Pathology	84702	CPT	3001366		Washington Regional Medical Center	outpatient	205	102.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	15.96	9.64	153.75
BETA-HCG QUANT SERUM	BETA-HCG QUANT SERUM	Laboratory & Pathology	84702	CPT	3001366		Washington Regional Medical Center	outpatient	205	102.5	Cigna	North Carolina PPO-PPA Direct	9.64	9.64	153.75
BETA-HCG QUANT SERUM	BETA-HCG QUANT SERUM	Laboratory & Pathology	84702	CPT	3001366		Washington Regional Medical Center	outpatient	205	102.5	Original Medicare	Traditional Medicare Fee-for-Service	96.35	9.64	153.75
BILI DIRECT	BILI DIRECT	Laboratory & Pathology	82248	CPT	3001008		Washington Regional Medical Center	outpatient	93	46.5	Self-Pay	Discounted Cash		3.33	69.75
BILI DIRECT	BILI DIRECT	Laboratory & Pathology	82248	CPT	3001008		Washington Regional Medical Center	outpatient	93	46.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	69.75	3.33	69.75
BILI DIRECT	BILI DIRECT	Laboratory & Pathology	82248	CPT	3001008		Washington Regional Medical Center	outpatient	93	46.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	40.92	3.33	69.75
BILI DIRECT	BILI DIRECT	Laboratory & Pathology	82248	CPT	3001008		Washington Regional Medical Center	outpatient	93	46.5	Humana	Medicare Advantage HMO/PPO/PFFS	43.71	3.33	69.75
BILI DIRECT	BILI DIRECT	Laboratory & Pathology	82248	CPT	3001008		Washington Regional Medical Center	outpatient	93	46.5	AmeriHealth Caritas North Carolina	NC Medicaid	9.16	3.33	69.75
BILI DIRECT	BILI DIRECT	Laboratory & Pathology	82248	CPT	3001008		Washington Regional Medical Center	outpatient	93	46.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	9.16	3.33	69.75
BILI DIRECT	BILI DIRECT	Laboratory & Pathology	82248	CPT	3001008		Washington Regional Medical Center	outpatient	93	46.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	9.16	3.33	69.75
BILI DIRECT	BILI DIRECT	Laboratory & Pathology	82248	CPT	3001008		Washington Regional Medical Center	outpatient	93	46.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	9.16	3.33	69.75
BILI DIRECT	BILI DIRECT	Laboratory & Pathology	82248	CPT	3001008		Washington Regional Medical Center	outpatient	93	46.5	Cigna	North Carolina PPO-PPA Direct	3.33	3.33	69.75
BILI DIRECT	BILI DIRECT	Laboratory & Pathology	82248	CPT	3001008		Washington Regional Medical Center	outpatient	93	46.5	Original Medicare	Traditional Medicare Fee-for-Service	43.71	3.33	69.75
Blood test, clotting time	PROTHROMBIN TIME	Laboratory & Pathology	85610	CPT	3001043		Washington Regional Medical Center	outpatient	106	53	Self-Pay	Discounted Cash		3.93	79.5
Blood test, clotting time	PROTHROMBIN TIME	Laboratory & Pathology	85610	CPT	3001043		Washington Regional Medical Center	outpatient	106	53	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	79.5	3.93	79.5
Blood test, clotting time	PROTHROMBIN TIME	Laboratory & Pathology	85610	CPT	3001043		Washington Regional Medical Center	outpatient	106	53	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	46.64	3.93	79.5
Blood test, clotting time	PROTHROMBIN TIME	Laboratory & Pathology	85610	CPT	3001043		Washington Regional Medical Center	outpatient	106	53	Humana	Medicare Advantage HMO/PPO/PFFS	49.82	3.93	79.5
Blood test, clotting time	PROTHROMBIN TIME	Laboratory & Pathology	85610	CPT	3001043		Washington Regional Medical Center	outpatient	106	53	AmeriHealth Caritas North Carolina	NC Medicaid	7.17	3.93	79.5
Blood test, clotting time	PROTHROMBIN TIME	Laboratory & Pathology	85610	CPT	3001043		Washington Regional Medical Center	outpatient	106	53	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	7.17	3.93	79.5
Blood test, clotting time	PROTHROMBIN TIME	Laboratory & Pathology	85610	CPT	3001043		Washington Regional Medical Center	outpatient	106	53	WellCare of North Carolina	North Carolina Medicaid/CHIP	7.17	3.93	79.5
Blood test, clotting time	PROTHROMBIN TIME	Laboratory & Pathology	85610	CPT	3001043		Washington Regional Medical Center	outpatient	106	53	Healthy Blue / Blue Cross NC	North Carolina Medicaid	7.17	3.93	79.5
Blood test, clotting time	PROTHROMBIN TIME	Laboratory & Pathology	85610	CPT	3001043		Washington Regional Medical Center	outpatient	106	53	Cigna	North Carolina PPO-PPA Direct	3.93	3.93	79.5
Blood test, clotting time	PROTHROMBIN TIME	Laboratory & Pathology	85610	CPT	3001043		Washington Regional Medical Center	outpatient	106	53	Original Medicare	Traditional Medicare Fee-for-Service	49.82	3.93	79.5
Blood test, comprehensive group of blood chemicals	COMPREHENSIVE METABOLIC PANEL	Laboratory & Pathology	80053	CPT	3001072		Washington Regional Medical Center	outpatient	350	175	Self-Pay	Discounted Cash		6.84	262.5
Blood test, comprehensive group of blood chemicals	COMPREHENSIVE METABOLIC PANEL	Laboratory & Pathology	80053	CPT	3001072		Washington Regional Medical Center	outpatient	350	175	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	262.5	6.84	262.5
Blood test, comprehensive group of blood chemicals	COMPREHENSIVE METABOLIC PANEL	Laboratory & Pathology	80053	CPT	3001072		Washington Regional Medical Center	outpatient	350	175	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	154	6.84	262.5
Blood test, comprehensive group of blood chemicals	COMPREHENSIVE METABOLIC PANEL	Laboratory & Pathology	80053	CPT	3001072		Washington Regional Medical Center	outpatient	350	175	Humana	Medicare Advantage HMO/PPO/PFFS	164.5	6.84	262.5
Blood test, comprehensive group of blood chemicals	COMPREHENSIVE METABOLIC PANEL	Laboratory & Pathology	80053	CPT	3001072		Washington Regional Medical Center	outpatient	350	175	AmeriHealth Caritas North Carolina	NC Medicaid	15.41	6.84	262.5
Blood test, comprehensive group of blood chemicals	COMPREHENSIVE METABOLIC PANEL	Laboratory & Pathology	80053	CPT	3001072		Washington Regional Medical Center	outpatient	350	175	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	15.41	6.84	262.5
Blood test, comprehensive group of blood chemicals	COMPREHENSIVE METABOLIC PANEL	Laboratory & Pathology	80053	CPT	3001072		Washington Regional Medical Center	outpatient	350	175	WellCare of North Carolina	North Carolina Medicaid/CHIP	15.41	6.84	262.5
Blood test, comprehensive group of blood chemicals	COMPREHENSIVE METABOLIC PANEL	Laboratory & Pathology	80053	CPT	3001072		Washington Regional Medical Center	outpatient	350	175	Healthy Blue / Blue Cross NC	North Carolina Medicaid	15.41	6.84	262.5
Blood test, comprehensive group of blood chemicals	COMPREHENSIVE METABOLIC PANEL	Laboratory & Pathology	80053	CPT	3001072		Washington Regional Medical Center	outpatient	350	175	Cigna	North Carolina PPO-PPA Direct	6.84	6.84	262.5
Blood test, comprehensive group of blood chemicals	COMPREHENSIVE METABOLIC PANEL	Laboratory & Pathology	80053	CPT	3001072		Washington Regional Medical Center	outpatient	350	175	Original Medicare	Traditional Medicare Fee-for-Service	164.5	6.84	262.5
Blood test, lipids (cholesterol and triglycerides)	LIPID PANEL	Laboratory & Pathology	80061	CPT	3001064		Washington Regional Medical Center	outpatient	190	95	Self-Pay	Discounted Cash		22.44	142.5
Blood test, lipids (cholesterol and triglycerides)	LIPID PANEL	Laboratory & Pathology	80061	CPT	3001064		Washington Regional Medical Center	outpatient	190	95	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	142.5	22.44	142.5
Blood test, lipids (cholesterol and triglycerides)	LIPID PANEL	Laboratory & Pathology	80061	CPT	3001064		Washington Regional Medical Center	outpatient	190	95	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	83.6	22.44	142.5
Blood test, lipids (cholesterol and triglycerides)	LIPID PANEL	Laboratory & Pathology	80061	CPT	3001064		Washington Regional Medical Center	outpatient	190	95	Humana	Medicare Advantage HMO/PPO/PFFS	89.3	22.44	142.5
Blood test, lipids (cholesterol and triglycerides)	LIPID PANEL	Laboratory & Pathology	80061	CPT	3001064		Washington Regional Medical Center	outpatient	190	95	AmeriHealth Caritas North Carolina	NC Medicaid	24.45	22.44	142.5
Blood test, lipids (cholesterol and triglycerides)	LIPID PANEL	Laboratory & Pathology	80061	CPT	3001064		Washington Regional Medical Center	outpatient	190	95	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	24.45	22.44	142.5
Blood test, lipids (cholesterol and triglycerides)	LIPID PANEL	Laboratory & Pathology	80061	CPT	3001064		Washington Regional Medical Center	outpatient	190	95	WellCare of North Carolina	North Carolina Medicaid/CHIP	24.45	22.44	142.5
Blood test, lipids (cholesterol and triglycerides)	LIPID PANEL	Laboratory & Pathology	80061	CPT	3001064		Washington Regional Medical Center	outpatient	190	95	Healthy Blue / Blue Cross NC	North Carolina Medicaid	24.45	22.44	142.5
Blood test, lipids (cholesterol and triglycerides)	LIPID PANEL	Laboratory & Pathology	80061	CPT	3001064		Washington Regional Medical Center	outpatient	190	95	Cigna	North Carolina PPO-PPA Direct	22.44	22.44	142.5
Blood test, lipids (cholesterol and triglycerides)	LIPID PANEL	Laboratory & Pathology	80061	CPT	3001064		Washington Regional Medical Center	outpatient	190	95	Original Medicare	Traditional Medicare Fee-for-Service	89.3	22.44	142.5
Blood test, thyroid stimulating hormone (TSH)	TSH	Laboratory & Pathology	84443	CPT	3001054		Washington Regional Medical Center	outpatient	175	87.5	Self-Pay	Discounted Cash		17.39	131.25
Blood test, thyroid stimulating hormone (TSH)	TSH	Laboratory & Pathology	84443	CPT	3001054		Washington Regional Medical Center	outpatient	175	87.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	131.25	17.39	131.25
Blood test, thyroid stimulating hormone (TSH)	TSH	Laboratory & Pathology	84443	CPT	3001054		Washington Regional Medical Center	outpatient	175	87.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	77	17.39	131.25
Blood test, thyroid stimulating hormone (TSH)	TSH	Laboratory & Pathology	84443	CPT	3001054		Washington Regional Medical Center	outpatient	175	87.5	Humana	Medicare Advantage HMO/PPO/PFFS	82.25	17.39	131.25
Blood test, thyroid stimulating hormone (TSH)	TSH	Laboratory & Pathology	84443	CPT	3001054		Washington Regional Medical Center	outpatient	175	87.5	AmeriHealth Caritas North Carolina	NC Medicaid	29.73	17.39	131.25
Blood test, thyroid stimulating hormone (TSH)	TSH	Laboratory & Pathology	84443	CPT	3001054		Washington Regional Medical Center	outpatient	175	87.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	29.73	17.39	131.25
Blood test, thyroid stimulating hormone (TSH)	TSH	Laboratory & Pathology	84443	CPT	3001054		Washington Regional Medical Center	outpatient	175	87.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	29.73	17.39	131.25
Blood test, thyroid stimulating hormone (TSH)	TSH	Laboratory & Pathology	84443	CPT	3001054		Washington Regional Medical Center	outpatient	175	87.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	29.73	17.39	131.25
Blood test, thyroid stimulating hormone (TSH)	TSH	Laboratory & Pathology	84443	CPT	3001054		Washington Regional Medical Center	outpatient	175	87.5	Cigna	North Carolina PPO-PPA Direct	17.39	17.39	131.25
Blood test, thyroid stimulating hormone (TSH)	TSH	Laboratory & Pathology	84443	CPT	3001054		Washington Regional Medical Center	outpatient	175	87.5	Original Medicare	Traditional Medicare Fee-for-Service	82.25	17.39	131.25
CAFFEINE	CAFFEINE	Laboratory & Pathology	80155	CPT	3002605		Washington Regional Medical Center	outpatient	114	57	Self-Pay	Discounted Cash		9.46	85.5
CAFFEINE	CAFFEINE	Laboratory & Pathology	80155	CPT	3002605		Washington Regional Medical Center	outpatient	114	57	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	85.5	9.46	85.5
CAFFEINE	CAFFEINE	Laboratory & Pathology	80155	CPT	3002605		Washington Regional Medical Center	outpatient	114	57	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	50.16	9.46	85.5
CAFFEINE	CAFFEINE	Laboratory & Pathology	80155	CPT	3002605		Washington Regional Medical Center	outpatient	114	57	Humana	Medicare Advantage HMO/PPO/PFFS	53.58	9.46	85.5
CAFFEINE	CAFFEINE	Laboratory & Pathology	80155	CPT	3002605		Washington Regional Medical Center	outpatient	114	57	AmeriHealth Caritas North Carolina	NC Medicaid	25.19	9.46	85.5
CAFFEINE	CAFFEINE	Laboratory & Pathology	80155	CPT	3002605		Washington Regional Medical Center	outpatient	114	57	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	25.19	9.46	85.5
CAFFEINE	CAFFEINE	Laboratory & Pathology	80155	CPT	3002605		Washington Regional Medical Center	outpatient	114	57	WellCare of North Carolina	North Carolina Medicaid/CHIP	25.19	9.46	85.5
CAFFEINE	CAFFEINE	Laboratory & Pathology	80155	CPT	3002605		Washington Regional Medical Center	outpatient	114	57	Healthy Blue / Blue Cross NC	North Carolina Medicaid	25.19	9.46	85.5
CAFFEINE	CAFFEINE	Laboratory & Pathology	80155	CPT	3002605		Washington Regional Medical Center	outpatient	114	57	Cigna	North Carolina PPO-PPA Direct	9.46	9.46	85.5
CAFFEINE	CAFFEINE	Laboratory & Pathology	80155	CPT	3002605		Washington Regional Medical Center	outpatient	114	57	Original Medicare	Traditional Medicare Fee-for-Service	53.58	9.46	85.5
CALCIUM	CALCIUM	Laboratory & Pathology	82310	CPT	3001011		Washington Regional Medical Center	outpatient	73	36.5	Self-Pay	Discounted Cash		3.33	54.75
CALCIUM	CALCIUM	Laboratory & Pathology	82310	CPT	3001011		Washington Regional Medical Center	outpatient	73	36.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	54.75	3.33	54.75
CALCIUM	CALCIUM	Laboratory & Pathology	82310	CPT	3001011		Washington Regional Medical Center	outpatient	73	36.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	32.12	3.33	54.75
CALCIUM	CALCIUM	Laboratory & Pathology	82310	CPT	3001011		Washington Regional Medical Center	outpatient	73	36.5	Humana	Medicare Advantage HMO/PPO/PFFS	34.31	3.33	54.75
CALCIUM	CALCIUM	Laboratory & Pathology	82310	CPT	3001011		Washington Regional Medical Center	outpatient	73	36.5	AmeriHealth Caritas North Carolina	NC Medicaid	9.4	3.33	54.75
CALCIUM	CALCIUM	Laboratory & Pathology	82310	CPT	3001011		Washington Regional Medical Center	outpatient	73	36.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	9.4	3.33	54.75
CALCIUM	CALCIUM	Laboratory & Pathology	82310	CPT	3001011		Washington Regional Medical Center	outpatient	73	36.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	9.4	3.33	54.75
CALCIUM	CALCIUM	Laboratory & Pathology	82310	CPT	3001011		Washington Regional Medical Center	outpatient	73	36.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	9.4	3.33	54.75
CALCIUM	CALCIUM	Laboratory & Pathology	82310	CPT	3001011		Washington Regional Medical Center	outpatient	73	36.5	Cigna	North Carolina PPO-PPA Direct	3.33	3.33	54.75
CALCIUM	CALCIUM	Laboratory & Pathology	82310	CPT	3001011		Washington Regional Medical Center	outpatient	73	36.5	Original Medicare	Traditional Medicare Fee-for-Service	34.31	3.33	54.75
CARBAMAZEPINE	CARBAMAZEPINE	Laboratory & Pathology	80156	CPT	3001075		Washington Regional Medical Center	outpatient	166	83	Self-Pay	Discounted Cash		9.46	124.5
CARBAMAZEPINE	CARBAMAZEPINE	Laboratory & Pathology	80156	CPT	3001075		Washington Regional Medical Center	outpatient	166	83	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	124.5	9.46	124.5
CARBAMAZEPINE	CARBAMAZEPINE	Laboratory & Pathology	80156	CPT	3001075		Washington Regional Medical Center	outpatient	166	83	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	73.04	9.46	124.5
CARBAMAZEPINE	CARBAMAZEPINE	Laboratory & Pathology	80156	CPT	3001075		Washington Regional Medical Center	outpatient	166	83	Humana	Medicare Advantage HMO/PPO/PFFS	78.02	9.46	124.5
CARBAMAZEPINE	CARBAMAZEPINE	Laboratory & Pathology	80156	CPT	3001075		Washington Regional Medical Center	outpatient	166	83	AmeriHealth Caritas North Carolina	NC Medicaid	26.55	9.46	124.5
CARBAMAZEPINE	CARBAMAZEPINE	Laboratory & Pathology	80156	CPT	3001075		Washington Regional Medical Center	outpatient	166	83	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	26.55	9.46	124.5
CARBAMAZEPINE	CARBAMAZEPINE	Laboratory & Pathology	80156	CPT	3001075		Washington Regional Medical Center	outpatient	166	83	WellCare of North Carolina	North Carolina Medicaid/CHIP	26.55	9.46	124.5
CARBAMAZEPINE	CARBAMAZEPINE	Laboratory & Pathology	80156	CPT	3001075		Washington Regional Medical Center	outpatient	166	83	Healthy Blue / Blue Cross NC	North Carolina Medicaid	26.55	9.46	124.5
CARBAMAZEPINE	CARBAMAZEPINE	Laboratory & Pathology	80156	CPT	3001075		Washington Regional Medical Center	outpatient	166	83	Cigna	North Carolina PPO-PPA Direct	9.46	9.46	124.5
CARBAMAZEPINE	CARBAMAZEPINE	Laboratory & Pathology	80156	CPT	3001075		Washington Regional Medical Center	outpatient	166	83	Original Medicare	Traditional Medicare Fee-for-Service	78.02	9.46	124.5
CARCINOEMBRYONIC ANTIGEN CEA	CARCINOEMBRYONIC ANTIGEN CEA	Laboratory & Pathology	82378	CPT	3001139		Washington Regional Medical Center	outpatient	213	106.5	Self-Pay	Discounted Cash		12.27	159.75
CARCINOEMBRYONIC ANTIGEN CEA	CARCINOEMBRYONIC ANTIGEN CEA	Laboratory & Pathology	82378	CPT	3001139		Washington Regional Medical Center	outpatient	213	106.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	159.75	12.27	159.75
CARCINOEMBRYONIC ANTIGEN CEA	CARCINOEMBRYONIC ANTIGEN CEA	Laboratory & Pathology	82378	CPT	3001139		Washington Regional Medical Center	outpatient	213	106.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	93.72	12.27	159.75
CARCINOEMBRYONIC ANTIGEN CEA	CARCINOEMBRYONIC ANTIGEN CEA	Laboratory & Pathology	82378	CPT	3001139		Washington Regional Medical Center	outpatient	213	106.5	Humana	Medicare Advantage HMO/PPO/PFFS	100.11	12.27	159.75
CARCINOEMBRYONIC ANTIGEN CEA	CARCINOEMBRYONIC ANTIGEN CEA	Laboratory & Pathology	82378	CPT	3001139		Washington Regional Medical Center	outpatient	213	106.5	AmeriHealth Caritas North Carolina	NC Medicaid	34.6	12.27	159.75
CARCINOEMBRYONIC ANTIGEN CEA	CARCINOEMBRYONIC ANTIGEN CEA	Laboratory & Pathology	82378	CPT	3001139		Washington Regional Medical Center	outpatient	213	106.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	34.6	12.27	159.75
CARCINOEMBRYONIC ANTIGEN CEA	CARCINOEMBRYONIC ANTIGEN CEA	Laboratory & Pathology	82378	CPT	3001139		Washington Regional Medical Center	outpatient	213	106.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	34.6	12.27	159.75
CARCINOEMBRYONIC ANTIGEN CEA	CARCINOEMBRYONIC ANTIGEN CEA	Laboratory & Pathology	82378	CPT	3001139		Washington Regional Medical Center	outpatient	213	106.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	34.6	12.27	159.75
CARCINOEMBRYONIC ANTIGEN CEA	CARCINOEMBRYONIC ANTIGEN CEA	Laboratory & Pathology	82378	CPT	3001139		Washington Regional Medical Center	outpatient	213	106.5	Cigna	North Carolina PPO-PPA Direct	12.27	12.27	159.75
CARCINOEMBRYONIC ANTIGEN CEA	CARCINOEMBRYONIC ANTIGEN CEA	Laboratory & Pathology	82378	CPT	3001139		Washington Regional Medical Center	outpatient	213	106.5	Original Medicare	Traditional Medicare Fee-for-Service	100.11	12.27	159.75
CELL SURF MARKER ADD	CELL SURF MARKER ADD	Laboratory & Pathology	88185	CPT	3002275		Washington Regional Medical Center	outpatient	110	55	Self-Pay	Discounted Cash		11.46	82.5
CELL SURF MARKER ADD	CELL SURF MARKER ADD	Laboratory & Pathology	88185	CPT	3002275		Washington Regional Medical Center	outpatient	110	55	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	82.5	11.46	82.5
CELL SURF MARKER ADD	CELL SURF MARKER ADD	Laboratory & Pathology	88185	CPT	3002275		Washington Regional Medical Center	outpatient	110	55	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	48.4	11.46	82.5
CELL SURF MARKER ADD	CELL SURF MARKER ADD	Laboratory & Pathology	88185	CPT	3002275		Washington Regional Medical Center	outpatient	110	55	Humana	Medicare Advantage HMO/PPO/PFFS	51.7	11.46	82.5
CELL SURF MARKER ADD	CELL SURF MARKER ADD	Laboratory & Pathology	88185	CPT	3002275		Washington Regional Medical Center	outpatient	110	55	AmeriHealth Caritas North Carolina	NC Medicaid	53.12	11.46	82.5
CELL SURF MARKER ADD	CELL SURF MARKER ADD	Laboratory & Pathology	88185	CPT	3002275		Washington Regional Medical Center	outpatient	110	55	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	53.12	11.46	82.5
CELL SURF MARKER ADD	CELL SURF MARKER ADD	Laboratory & Pathology	88185	CPT	3002275		Washington Regional Medical Center	outpatient	110	55	WellCare of North Carolina	North Carolina Medicaid/CHIP	53.12	11.46	82.5
CELL SURF MARKER ADD	CELL SURF MARKER ADD	Laboratory & Pathology	88185	CPT	3002275		Washington Regional Medical Center	outpatient	110	55	Healthy Blue / Blue Cross NC	North Carolina Medicaid	53.12	11.46	82.5
CELL SURF MARKER ADD	CELL SURF MARKER ADD	Laboratory & Pathology	88185	CPT	3002275		Washington Regional Medical Center	outpatient	110	55	Cigna	North Carolina PPO-PPA Direct	11.46	11.46	82.5
CELL SURF MARKER ADD	CELL SURF MARKER ADD	Laboratory & Pathology	88185	CPT	3002275		Washington Regional Medical Center	outpatient	110	55	Original Medicare	Traditional Medicare Fee-for-Service	51.7	11.46	82.5
CHOLINESTERASE SERUM OR PLASMA	CHOLINESTERASE SERUM OR PLASMA	Laboratory & Pathology	82480	CPT	3001304		Washington Regional Medical Center	outpatient	120	60	Self-Pay	Discounted Cash		5.08	90
CHOLINESTERASE SERUM OR PLASMA	CHOLINESTERASE SERUM OR PLASMA	Laboratory & Pathology	82480	CPT	3001304		Washington Regional Medical Center	outpatient	120	60	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	90	5.08	90
CHOLINESTERASE SERUM OR PLASMA	CHOLINESTERASE SERUM OR PLASMA	Laboratory & Pathology	82480	CPT	3001304		Washington Regional Medical Center	outpatient	120	60	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	52.8	5.08	90
CHOLINESTERASE SERUM OR PLASMA	CHOLINESTERASE SERUM OR PLASMA	Laboratory & Pathology	82480	CPT	3001304		Washington Regional Medical Center	outpatient	120	60	Humana	Medicare Advantage HMO/PPO/PFFS	56.4	5.08	90
CHOLINESTERASE SERUM OR PLASMA	CHOLINESTERASE SERUM OR PLASMA	Laboratory & Pathology	82480	CPT	3001304		Washington Regional Medical Center	outpatient	120	60	AmeriHealth Caritas North Carolina	NC Medicaid	10.48	5.08	90
CHOLINESTERASE SERUM OR PLASMA	CHOLINESTERASE SERUM OR PLASMA	Laboratory & Pathology	82480	CPT	3001304		Washington Regional Medical Center	outpatient	120	60	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	10.48	5.08	90
CHOLINESTERASE SERUM OR PLASMA	CHOLINESTERASE SERUM OR PLASMA	Laboratory & Pathology	82480	CPT	3001304		Washington Regional Medical Center	outpatient	120	60	WellCare of North Carolina	North Carolina Medicaid/CHIP	10.48	5.08	90
CHOLINESTERASE SERUM OR PLASMA	CHOLINESTERASE SERUM OR PLASMA	Laboratory & Pathology	82480	CPT	3001304		Washington Regional Medical Center	outpatient	120	60	Healthy Blue / Blue Cross NC	North Carolina Medicaid	10.48	5.08	90
CHOLINESTERASE SERUM OR PLASMA	CHOLINESTERASE SERUM OR PLASMA	Laboratory & Pathology	82480	CPT	3001304		Washington Regional Medical Center	outpatient	120	60	Cigna	North Carolina PPO-PPA Direct	5.08	5.08	90
CHOLINESTERASE SERUM OR PLASMA	CHOLINESTERASE SERUM OR PLASMA	Laboratory & Pathology	82480	CPT	3001304		Washington Regional Medical Center	outpatient	120	60	Original Medicare	Traditional Medicare Fee-for-Service	56.4	5.08	90
CHROMOGRANIN A	CHROMOGRANIN A	Laboratory & Pathology	86316	CPT	3001930		Washington Regional Medical Center	outpatient	265	132.5	Self-Pay	Discounted Cash		13.5	198.75
CHROMOGRANIN A	CHROMOGRANIN A	Laboratory & Pathology	86316	CPT	3001930		Washington Regional Medical Center	outpatient	265	132.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	198.75	13.5	198.75
CHROMOGRANIN A	CHROMOGRANIN A	Laboratory & Pathology	86316	CPT	3001930		Washington Regional Medical Center	outpatient	265	132.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	116.6	13.5	198.75
CHROMOGRANIN A	CHROMOGRANIN A	Laboratory & Pathology	86316	CPT	3001930		Washington Regional Medical Center	outpatient	265	132.5	Humana	Medicare Advantage HMO/PPO/PFFS	124.55	13.5	198.75
CHROMOGRANIN A	CHROMOGRANIN A	Laboratory & Pathology	86316	CPT	3001930		Washington Regional Medical Center	outpatient	265	132.5	AmeriHealth Caritas North Carolina	NC Medicaid	37.94	13.5	198.75
CHROMOGRANIN A	CHROMOGRANIN A	Laboratory & Pathology	86316	CPT	3001930		Washington Regional Medical Center	outpatient	265	132.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	37.94	13.5	198.75
CHROMOGRANIN A	CHROMOGRANIN A	Laboratory & Pathology	86316	CPT	3001930		Washington Regional Medical Center	outpatient	265	132.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	37.94	13.5	198.75
CHROMOGRANIN A	CHROMOGRANIN A	Laboratory & Pathology	86316	CPT	3001930		Washington Regional Medical Center	outpatient	265	132.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	37.94	13.5	198.75
CHROMOGRANIN A	CHROMOGRANIN A	Laboratory & Pathology	86316	CPT	3001930		Washington Regional Medical Center	outpatient	265	132.5	Cigna	North Carolina PPO-PPA Direct	13.5	13.5	198.75
CHROMOGRANIN A	CHROMOGRANIN A	Laboratory & Pathology	86316	CPT	3001930		Washington Regional Medical Center	outpatient	265	132.5	Original Medicare	Traditional Medicare Fee-for-Service	124.55	13.5	198.75
CLOZAPINE	CLOZAPINE	Laboratory & Pathology	80159	CPT	3001605		Washington Regional Medical Center	outpatient	222	111	Self-Pay	Discounted Cash		12.27	166.5
CLOZAPINE	CLOZAPINE	Laboratory & Pathology	80159	CPT	3001605		Washington Regional Medical Center	outpatient	222	111	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	166.5	12.27	166.5
CLOZAPINE	CLOZAPINE	Laboratory & Pathology	80159	CPT	3001605		Washington Regional Medical Center	outpatient	222	111	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	97.68	12.27	166.5
CLOZAPINE	CLOZAPINE	Laboratory & Pathology	80159	CPT	3001605		Washington Regional Medical Center	outpatient	222	111	Humana	Medicare Advantage HMO/PPO/PFFS	104.34	12.27	166.5
CLOZAPINE	CLOZAPINE	Laboratory & Pathology	80159	CPT	3001605		Washington Regional Medical Center	outpatient	222	111	AmeriHealth Caritas North Carolina	NC Medicaid	32.94	12.27	166.5
CLOZAPINE	CLOZAPINE	Laboratory & Pathology	80159	CPT	3001605		Washington Regional Medical Center	outpatient	222	111	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	32.94	12.27	166.5
CLOZAPINE	CLOZAPINE	Laboratory & Pathology	80159	CPT	3001605		Washington Regional Medical Center	outpatient	222	111	WellCare of North Carolina	North Carolina Medicaid/CHIP	32.94	12.27	166.5
CLOZAPINE	CLOZAPINE	Laboratory & Pathology	80159	CPT	3001605		Washington Regional Medical Center	outpatient	222	111	Healthy Blue / Blue Cross NC	North Carolina Medicaid	32.94	12.27	166.5
CLOZAPINE	CLOZAPINE	Laboratory & Pathology	80159	CPT	3001605		Washington Regional Medical Center	outpatient	222	111	Cigna	North Carolina PPO-PPA Direct	12.27	12.27	166.5
CLOZAPINE	CLOZAPINE	Laboratory & Pathology	80159	CPT	3001605		Washington Regional Medical Center	outpatient	222	111	Original Medicare	Traditional Medicare Fee-for-Service	104.34	12.27	166.5
CMV IGG	CMV IGG	Laboratory & Pathology	86644	CPT	3001312		Washington Regional Medical Center	outpatient	125	62.5	Self-Pay	Discounted Cash		9.29	93.75
CMV IGG	CMV IGG	Laboratory & Pathology	86644	CPT	3001312		Washington Regional Medical Center	outpatient	125	62.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	93.75	9.29	93.75
CMV IGG	CMV IGG	Laboratory & Pathology	86644	CPT	3001312		Washington Regional Medical Center	outpatient	125	62.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	55	9.29	93.75
CMV IGG	CMV IGG	Laboratory & Pathology	86644	CPT	3001312		Washington Regional Medical Center	outpatient	125	62.5	Humana	Medicare Advantage HMO/PPO/PFFS	58.75	9.29	93.75
CMV IGG	CMV IGG	Laboratory & Pathology	86644	CPT	3001312		Washington Regional Medical Center	outpatient	125	62.5	AmeriHealth Caritas North Carolina	NC Medicaid	26.2	9.29	93.75
CMV IGG	CMV IGG	Laboratory & Pathology	86644	CPT	3001312		Washington Regional Medical Center	outpatient	125	62.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	26.2	9.29	93.75
CMV IGG	CMV IGG	Laboratory & Pathology	86644	CPT	3001312		Washington Regional Medical Center	outpatient	125	62.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	26.2	9.29	93.75
CMV IGG	CMV IGG	Laboratory & Pathology	86644	CPT	3001312		Washington Regional Medical Center	outpatient	125	62.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	26.2	9.29	93.75
CMV IGG	CMV IGG	Laboratory & Pathology	86644	CPT	3001312		Washington Regional Medical Center	outpatient	125	62.5	Cigna	North Carolina PPO-PPA Direct	9.29	9.29	93.75
CMV IGG	CMV IGG	Laboratory & Pathology	86644	CPT	3001312		Washington Regional Medical Center	outpatient	125	62.5	Original Medicare	Traditional Medicare Fee-for-Service	58.75	9.29	93.75
Coagulation assessment blood test	PTT	Laboratory & Pathology	85730	CPT	3001044		Washington Regional Medical Center	outpatient	100	50	Self-Pay	Discounted Cash		3.86	75
Coagulation assessment blood test	PTT	Laboratory & Pathology	85730	CPT	3001044		Washington Regional Medical Center	outpatient	100	50	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	75	3.86	75
Coagulation assessment blood test	PTT	Laboratory & Pathology	85730	CPT	3001044		Washington Regional Medical Center	outpatient	100	50	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	44	3.86	75
Coagulation assessment blood test	PTT	Laboratory & Pathology	85730	CPT	3001044		Washington Regional Medical Center	outpatient	100	50	Humana	Medicare Advantage HMO/PPO/PFFS	47	3.86	75
Coagulation assessment blood test	PTT	Laboratory & Pathology	85730	CPT	3001044		Washington Regional Medical Center	outpatient	100	50	AmeriHealth Caritas North Carolina	NC Medicaid	10.95	3.86	75
Coagulation assessment blood test	PTT	Laboratory & Pathology	85730	CPT	3001044		Washington Regional Medical Center	outpatient	100	50	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	10.95	3.86	75
Coagulation assessment blood test	PTT	Laboratory & Pathology	85730	CPT	3001044		Washington Regional Medical Center	outpatient	100	50	WellCare of North Carolina	North Carolina Medicaid/CHIP	10.95	3.86	75
Coagulation assessment blood test	PTT	Laboratory & Pathology	85730	CPT	3001044		Washington Regional Medical Center	outpatient	100	50	Healthy Blue / Blue Cross NC	North Carolina Medicaid	10.95	3.86	75
Coagulation assessment blood test	PTT	Laboratory & Pathology	85730	CPT	3001044		Washington Regional Medical Center	outpatient	100	50	Cigna	North Carolina PPO-PPA Direct	3.86	3.86	75
Coagulation assessment blood test	PTT	Laboratory & Pathology	85730	CPT	3001044		Washington Regional Medical Center	outpatient	100	50	Original Medicare	Traditional Medicare Fee-for-Service	47	3.86	75
COCAINE	COCAINE	Laboratory & Pathology	80353	CPT	3000119		Washington Regional Medical Center	outpatient	4	2	Self-Pay	Discounted Cash		1.41	3
COCAINE	COCAINE	Laboratory & Pathology	80353	CPT	3000119		Washington Regional Medical Center	outpatient	4	2	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	3	1.41	3
COCAINE	COCAINE	Laboratory & Pathology	80353	CPT	3000119		Washington Regional Medical Center	outpatient	4	2	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	1.76	1.41	3
COCAINE	COCAINE	Laboratory & Pathology	80353	CPT	3000119		Washington Regional Medical Center	outpatient	4	2	Humana	Medicare Advantage HMO/PPO/PFFS	1.88	1.41	3
COCAINE	COCAINE	Laboratory & Pathology	80353	CPT	3000119		Washington Regional Medical Center	outpatient	4	2	AmeriHealth Caritas North Carolina	NC Medicaid	1.41	1.41	3
COCAINE	COCAINE	Laboratory & Pathology	80353	CPT	3000119		Washington Regional Medical Center	outpatient	4	2	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	1.41	1.41	3
COCAINE	COCAINE	Laboratory & Pathology	80353	CPT	3000119		Washington Regional Medical Center	outpatient	4	2	WellCare of North Carolina	North Carolina Medicaid/CHIP	1.41	1.41	3
COCAINE	COCAINE	Laboratory & Pathology	80353	CPT	3000119		Washington Regional Medical Center	outpatient	4	2	Healthy Blue / Blue Cross NC	North Carolina Medicaid	1.41	1.41	3
COCAINE	COCAINE	Laboratory & Pathology	80353	CPT	3000119		Washington Regional Medical Center	outpatient	4	2	Original Medicare	Traditional Medicare Fee-for-Service	1.88	1.41	3
COLD AGGLUTININS SCREEN	COLD AGGLUTININS SCREEN	Laboratory & Pathology	86156	CPT	3001314		Washington Regional Medical Center	outpatient	112	56	Self-Pay	Discounted Cash		4.38	84
COLD AGGLUTININS SCREEN	COLD AGGLUTININS SCREEN	Laboratory & Pathology	86156	CPT	3001314		Washington Regional Medical Center	outpatient	112	56	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	84	4.38	84
COLD AGGLUTININS SCREEN	COLD AGGLUTININS SCREEN	Laboratory & Pathology	86156	CPT	3001314		Washington Regional Medical Center	outpatient	112	56	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	49.28	4.38	84
COLD AGGLUTININS SCREEN	COLD AGGLUTININS SCREEN	Laboratory & Pathology	86156	CPT	3001314		Washington Regional Medical Center	outpatient	112	56	Humana	Medicare Advantage HMO/PPO/PFFS	52.64	4.38	84
COLD AGGLUTININS SCREEN	COLD AGGLUTININS SCREEN	Laboratory & Pathology	86156	CPT	3001314		Washington Regional Medical Center	outpatient	112	56	AmeriHealth Caritas North Carolina	NC Medicaid	11.71	4.38	84
COLD AGGLUTININS SCREEN	COLD AGGLUTININS SCREEN	Laboratory & Pathology	86156	CPT	3001314		Washington Regional Medical Center	outpatient	112	56	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	11.71	4.38	84
COLD AGGLUTININS SCREEN	COLD AGGLUTININS SCREEN	Laboratory & Pathology	86156	CPT	3001314		Washington Regional Medical Center	outpatient	112	56	WellCare of North Carolina	North Carolina Medicaid/CHIP	11.71	4.38	84
COLD AGGLUTININS SCREEN	COLD AGGLUTININS SCREEN	Laboratory & Pathology	86156	CPT	3001314		Washington Regional Medical Center	outpatient	112	56	Healthy Blue / Blue Cross NC	North Carolina Medicaid	11.71	4.38	84
COLD AGGLUTININS SCREEN	COLD AGGLUTININS SCREEN	Laboratory & Pathology	86156	CPT	3001314		Washington Regional Medical Center	outpatient	112	56	Cigna	North Carolina PPO-PPA Direct	4.38	4.38	84
COLD AGGLUTININS SCREEN	COLD AGGLUTININS SCREEN	Laboratory & Pathology	86156	CPT	3001314		Washington Regional Medical Center	outpatient	112	56	Original Medicare	Traditional Medicare Fee-for-Service	52.64	4.38	84
COLUMN CHROMOTOGRAPHY QUANT	COLUMN CHROMOTOGRAPHY QUANT	Laboratory & Pathology	82542	CPT	3002420		Washington Regional Medical Center	outpatient	356	178	Self-Pay	Discounted Cash		11.74	267
COLUMN CHROMOTOGRAPHY QUANT	COLUMN CHROMOTOGRAPHY QUANT	Laboratory & Pathology	82542	CPT	3002420		Washington Regional Medical Center	outpatient	356	178	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	267	11.74	267
COLUMN CHROMOTOGRAPHY QUANT	COLUMN CHROMOTOGRAPHY QUANT	Laboratory & Pathology	82542	CPT	3002420		Washington Regional Medical Center	outpatient	356	178	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	156.64	11.74	267
COLUMN CHROMOTOGRAPHY QUANT	COLUMN CHROMOTOGRAPHY QUANT	Laboratory & Pathology	82542	CPT	3002420		Washington Regional Medical Center	outpatient	356	178	Humana	Medicare Advantage HMO/PPO/PFFS	167.32	11.74	267
COLUMN CHROMOTOGRAPHY QUANT	COLUMN CHROMOTOGRAPHY QUANT	Laboratory & Pathology	82542	CPT	3002420		Washington Regional Medical Center	outpatient	356	178	AmeriHealth Caritas North Carolina	NC Medicaid	32.94	11.74	267
COLUMN CHROMOTOGRAPHY QUANT	COLUMN CHROMOTOGRAPHY QUANT	Laboratory & Pathology	82542	CPT	3002420		Washington Regional Medical Center	outpatient	356	178	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	32.94	11.74	267
COLUMN CHROMOTOGRAPHY QUANT	COLUMN CHROMOTOGRAPHY QUANT	Laboratory & Pathology	82542	CPT	3002420		Washington Regional Medical Center	outpatient	356	178	WellCare of North Carolina	North Carolina Medicaid/CHIP	32.94	11.74	267
COLUMN CHROMOTOGRAPHY QUANT	COLUMN CHROMOTOGRAPHY QUANT	Laboratory & Pathology	82542	CPT	3002420		Washington Regional Medical Center	outpatient	356	178	Healthy Blue / Blue Cross NC	North Carolina Medicaid	32.94	11.74	267
COLUMN CHROMOTOGRAPHY QUANT	COLUMN CHROMOTOGRAPHY QUANT	Laboratory & Pathology	82542	CPT	3002420		Washington Regional Medical Center	outpatient	356	178	Cigna	North Carolina PPO-PPA Direct	11.74	11.74	267
COLUMN CHROMOTOGRAPHY QUANT	COLUMN CHROMOTOGRAPHY QUANT	Laboratory & Pathology	82542	CPT	3002420		Washington Regional Medical Center	outpatient	356	178	Original Medicare	Traditional Medicare Fee-for-Service	167.32	11.74	267
Complete blood cell count, with differential white blood cells, automated	CBC W/ AUTO DIFF	Laboratory & Pathology	85025	CPT	3001035		Washington Regional Medical Center	outpatient	210	105	Self-Pay	Discounted Cash		8.13	157.5
Complete blood cell count, with differential white blood cells, automated	CBC W/ AUTO DIFF	Laboratory & Pathology	85025	CPT	3001035		Washington Regional Medical Center	outpatient	210	105	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	157.5	8.13	157.5
Complete blood cell count, with differential white blood cells, automated	CBC W/ AUTO DIFF	Laboratory & Pathology	85025	CPT	3001035		Washington Regional Medical Center	outpatient	210	105	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	92.4	8.13	157.5
Complete blood cell count, with differential white blood cells, automated	CBC W/ AUTO DIFF	Laboratory & Pathology	85025	CPT	3001035		Washington Regional Medical Center	outpatient	210	105	Humana	Medicare Advantage HMO/PPO/PFFS	98.7	8.13	157.5
Complete blood cell count, with differential white blood cells, automated	CBC W/ AUTO DIFF	Laboratory & Pathology	85025	CPT	3001035		Washington Regional Medical Center	outpatient	210	105	AmeriHealth Caritas North Carolina	NC Medicaid	14.17	8.13	157.5
Complete blood cell count, with differential white blood cells, automated	CBC W/ AUTO DIFF	Laboratory & Pathology	85025	CPT	3001035		Washington Regional Medical Center	outpatient	210	105	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	14.17	8.13	157.5
Complete blood cell count, with differential white blood cells, automated	CBC W/ AUTO DIFF	Laboratory & Pathology	85025	CPT	3001035		Washington Regional Medical Center	outpatient	210	105	WellCare of North Carolina	North Carolina Medicaid/CHIP	14.17	8.13	157.5
Complete blood cell count, with differential white blood cells, automated	CBC W/ AUTO DIFF	Laboratory & Pathology	85025	CPT	3001035		Washington Regional Medical Center	outpatient	210	105	Healthy Blue / Blue Cross NC	North Carolina Medicaid	14.17	8.13	157.5
Complete blood cell count, with differential white blood cells, automated	CBC W/ AUTO DIFF	Laboratory & Pathology	85025	CPT	3001035		Washington Regional Medical Center	outpatient	210	105	Cigna	North Carolina PPO-PPA Direct	8.13	8.13	157.5
Complete blood cell count, with differential white blood cells, automated	CBC W/ AUTO DIFF	Laboratory & Pathology	85025	CPT	3001035		Washington Regional Medical Center	outpatient	210	105	Original Medicare	Traditional Medicare Fee-for-Service	98.7	8.13	157.5
Complete blood count, automated	CBC W/O DIFF	Laboratory & Pathology	85027	CPT	3001040		Washington Regional Medical Center	outpatient	1055	527.5	Self-Pay	Discounted Cash		6.73	791.25
Complete blood count, automated	CBC W/O DIFF	Laboratory & Pathology	85027	CPT	3001040		Washington Regional Medical Center	outpatient	1055	527.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	791.25	6.73	791.25
Complete blood count, automated	CBC W/O DIFF	Laboratory & Pathology	85027	CPT	3001040		Washington Regional Medical Center	outpatient	1055	527.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	464.2	6.73	791.25
Complete blood count, automated	CBC W/O DIFF	Laboratory & Pathology	85027	CPT	3001040		Washington Regional Medical Center	outpatient	1055	527.5	Humana	Medicare Advantage HMO/PPO/PFFS	495.85	6.73	791.25
Complete blood count, automated	CBC W/O DIFF	Laboratory & Pathology	85027	CPT	3001040		Washington Regional Medical Center	outpatient	1055	527.5	AmeriHealth Caritas North Carolina	NC Medicaid	11.81	6.73	791.25
Complete blood count, automated	CBC W/O DIFF	Laboratory & Pathology	85027	CPT	3001040		Washington Regional Medical Center	outpatient	1055	527.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	11.81	6.73	791.25
Complete blood count, automated	CBC W/O DIFF	Laboratory & Pathology	85027	CPT	3001040		Washington Regional Medical Center	outpatient	1055	527.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	11.81	6.73	791.25
Complete blood count, automated	CBC W/O DIFF	Laboratory & Pathology	85027	CPT	3001040		Washington Regional Medical Center	outpatient	1055	527.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	11.81	6.73	791.25
Complete blood count, automated	CBC W/O DIFF	Laboratory & Pathology	85027	CPT	3001040		Washington Regional Medical Center	outpatient	1055	527.5	Cigna	North Carolina PPO-PPA Direct	6.73	6.73	791.25
Complete blood count, automated	CBC W/O DIFF	Laboratory & Pathology	85027	CPT	3001040		Washington Regional Medical Center	outpatient	1055	527.5	Original Medicare	Traditional Medicare Fee-for-Service	495.85	6.73	791.25
CULTURE ACID FAST	CULTURE ACID FAST	Laboratory & Pathology	87116	CPT	3001324		Washington Regional Medical Center	outpatient	175	87.5	Self-Pay	Discounted Cash		7.01	131.25
CULTURE ACID FAST	CULTURE ACID FAST	Laboratory & Pathology	87116	CPT	3001324		Washington Regional Medical Center	outpatient	175	87.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	131.25	7.01	131.25
CULTURE ACID FAST	CULTURE ACID FAST	Laboratory & Pathology	87116	CPT	3001324		Washington Regional Medical Center	outpatient	175	87.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	77	7.01	131.25
CULTURE ACID FAST	CULTURE ACID FAST	Laboratory & Pathology	87116	CPT	3001324		Washington Regional Medical Center	outpatient	175	87.5	Humana	Medicare Advantage HMO/PPO/PFFS	82.25	7.01	131.25
CULTURE ACID FAST	CULTURE ACID FAST	Laboratory & Pathology	87116	CPT	3001324		Washington Regional Medical Center	outpatient	175	87.5	AmeriHealth Caritas North Carolina	NC Medicaid	19.72	7.01	131.25
CULTURE ACID FAST	CULTURE ACID FAST	Laboratory & Pathology	87116	CPT	3001324		Washington Regional Medical Center	outpatient	175	87.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	19.72	7.01	131.25
CULTURE ACID FAST	CULTURE ACID FAST	Laboratory & Pathology	87116	CPT	3001324		Washington Regional Medical Center	outpatient	175	87.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	19.72	7.01	131.25
CULTURE ACID FAST	CULTURE ACID FAST	Laboratory & Pathology	87116	CPT	3001324		Washington Regional Medical Center	outpatient	175	87.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	19.72	7.01	131.25
CULTURE ACID FAST	CULTURE ACID FAST	Laboratory & Pathology	87116	CPT	3001324		Washington Regional Medical Center	outpatient	175	87.5	Cigna	North Carolina PPO-PPA Direct	7.01	7.01	131.25
CULTURE ACID FAST	CULTURE ACID FAST	Laboratory & Pathology	87116	CPT	3001324		Washington Regional Medical Center	outpatient	175	87.5	Original Medicare	Traditional Medicare Fee-for-Service	82.25	7.01	131.25
CULTURE BLOOD	CULTURE BLOOD	Laboratory & Pathology	87040	CPT	3001052		Washington Regional Medical Center	outpatient	155	77.5	Self-Pay	Discounted Cash		6.66	116.25
CULTURE BLOOD	CULTURE BLOOD	Laboratory & Pathology	87040	CPT	3001052		Washington Regional Medical Center	outpatient	155	77.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	116.25	6.66	116.25
CULTURE BLOOD	CULTURE BLOOD	Laboratory & Pathology	87040	CPT	3001052		Washington Regional Medical Center	outpatient	155	77.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	68.2	6.66	116.25
CULTURE BLOOD	CULTURE BLOOD	Laboratory & Pathology	87040	CPT	3001052		Washington Regional Medical Center	outpatient	155	77.5	Humana	Medicare Advantage HMO/PPO/PFFS	72.85	6.66	116.25
CULTURE BLOOD	CULTURE BLOOD	Laboratory & Pathology	87040	CPT	3001052		Washington Regional Medical Center	outpatient	155	77.5	AmeriHealth Caritas North Carolina	NC Medicaid	18.82	6.66	116.25
CULTURE BLOOD	CULTURE BLOOD	Laboratory & Pathology	87040	CPT	3001052		Washington Regional Medical Center	outpatient	155	77.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	18.82	6.66	116.25
CULTURE BLOOD	CULTURE BLOOD	Laboratory & Pathology	87040	CPT	3001052		Washington Regional Medical Center	outpatient	155	77.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	18.82	6.66	116.25
CULTURE BLOOD	CULTURE BLOOD	Laboratory & Pathology	87040	CPT	3001052		Washington Regional Medical Center	outpatient	155	77.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	18.82	6.66	116.25
CULTURE BLOOD	CULTURE BLOOD	Laboratory & Pathology	87040	CPT	3001052		Washington Regional Medical Center	outpatient	155	77.5	Cigna	North Carolina PPO-PPA Direct	6.66	6.66	116.25
CULTURE BLOOD	CULTURE BLOOD	Laboratory & Pathology	87040	CPT	3001052		Washington Regional Medical Center	outpatient	155	77.5	Original Medicare	Traditional Medicare Fee-for-Service	72.85	6.66	116.25
CULTURE THROAT (STREP A SCREEN)	CULTURE THROAT (STREP A SCREEN)	Laboratory & Pathology	87081	CPT	3001059		Washington Regional Medical Center	outpatient	100	50	Self-Pay	Discounted Cash		4.21	75
CULTURE THROAT (STREP A SCREEN)	CULTURE THROAT (STREP A SCREEN)	Laboratory & Pathology	87081	CPT	3001059		Washington Regional Medical Center	outpatient	100	50	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	75	4.21	75
CULTURE THROAT (STREP A SCREEN)	CULTURE THROAT (STREP A SCREEN)	Laboratory & Pathology	87081	CPT	3001059		Washington Regional Medical Center	outpatient	100	50	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	44	4.21	75
CULTURE THROAT (STREP A SCREEN)	CULTURE THROAT (STREP A SCREEN)	Laboratory & Pathology	87081	CPT	3001059		Washington Regional Medical Center	outpatient	100	50	Humana	Medicare Advantage HMO/PPO/PFFS	47	4.21	75
CULTURE THROAT (STREP A SCREEN)	CULTURE THROAT (STREP A SCREEN)	Laboratory & Pathology	87081	CPT	3001059		Washington Regional Medical Center	outpatient	100	50	AmeriHealth Caritas North Carolina	NC Medicaid	10.51	4.21	75
CULTURE THROAT (STREP A SCREEN)	CULTURE THROAT (STREP A SCREEN)	Laboratory & Pathology	87081	CPT	3001059		Washington Regional Medical Center	outpatient	100	50	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	10.51	4.21	75
CULTURE THROAT (STREP A SCREEN)	CULTURE THROAT (STREP A SCREEN)	Laboratory & Pathology	87081	CPT	3001059		Washington Regional Medical Center	outpatient	100	50	WellCare of North Carolina	North Carolina Medicaid/CHIP	10.51	4.21	75
CULTURE THROAT (STREP A SCREEN)	CULTURE THROAT (STREP A SCREEN)	Laboratory & Pathology	87081	CPT	3001059		Washington Regional Medical Center	outpatient	100	50	Healthy Blue / Blue Cross NC	North Carolina Medicaid	10.51	4.21	75
CULTURE THROAT (STREP A SCREEN)	CULTURE THROAT (STREP A SCREEN)	Laboratory & Pathology	87081	CPT	3001059		Washington Regional Medical Center	outpatient	100	50	Cigna	North Carolina PPO-PPA Direct	4.21	4.21	75
CULTURE THROAT (STREP A SCREEN)	CULTURE THROAT (STREP A SCREEN)	Laboratory & Pathology	87081	CPT	3001059		Washington Regional Medical Center	outpatient	100	50	Original Medicare	Traditional Medicare Fee-for-Service	47	4.21	75
CYCLOSPORIN	CYCLOSPORIN	Laboratory & Pathology	80158	CPT	3001331		Washington Regional Medical Center	outpatient	245	122.5	Self-Pay	Discounted Cash		11.74	183.75
CYCLOSPORIN	CYCLOSPORIN	Laboratory & Pathology	80158	CPT	3001331		Washington Regional Medical Center	outpatient	245	122.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	183.75	11.74	183.75
CYCLOSPORIN	CYCLOSPORIN	Laboratory & Pathology	80158	CPT	3001331		Washington Regional Medical Center	outpatient	245	122.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	107.8	11.74	183.75
CYCLOSPORIN	CYCLOSPORIN	Laboratory & Pathology	80158	CPT	3001331		Washington Regional Medical Center	outpatient	245	122.5	Humana	Medicare Advantage HMO/PPO/PFFS	115.15	11.74	183.75
CYCLOSPORIN	CYCLOSPORIN	Laboratory & Pathology	80158	CPT	3001331		Washington Regional Medical Center	outpatient	245	122.5	AmeriHealth Caritas North Carolina	NC Medicaid	32.94	11.74	183.75
CYCLOSPORIN	CYCLOSPORIN	Laboratory & Pathology	80158	CPT	3001331		Washington Regional Medical Center	outpatient	245	122.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	32.94	11.74	183.75
CYCLOSPORIN	CYCLOSPORIN	Laboratory & Pathology	80158	CPT	3001331		Washington Regional Medical Center	outpatient	245	122.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	32.94	11.74	183.75
CYCLOSPORIN	CYCLOSPORIN	Laboratory & Pathology	80158	CPT	3001331		Washington Regional Medical Center	outpatient	245	122.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	32.94	11.74	183.75
CYCLOSPORIN	CYCLOSPORIN	Laboratory & Pathology	80158	CPT	3001331		Washington Regional Medical Center	outpatient	245	122.5	Cigna	North Carolina PPO-PPA Direct	11.74	11.74	183.75
CYCLOSPORIN	CYCLOSPORIN	Laboratory & Pathology	80158	CPT	3001331		Washington Regional Medical Center	outpatient	245	122.5	Original Medicare	Traditional Medicare Fee-for-Service	115.15	11.74	183.75
DEXAMETHASONE	DEXAMETHASONE	Laboratory & Pathology	80299	CPT	3000089		Washington Regional Medical Center	outpatient	215	107.5	Self-Pay	Discounted Cash		8.76	161.25
DEXAMETHASONE	DEXAMETHASONE	Laboratory & Pathology	80299	CPT	3000089		Washington Regional Medical Center	outpatient	215	107.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	161.25	8.76	161.25
DEXAMETHASONE	DEXAMETHASONE	Laboratory & Pathology	80299	CPT	3000089		Washington Regional Medical Center	outpatient	215	107.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	94.6	8.76	161.25
DEXAMETHASONE	DEXAMETHASONE	Laboratory & Pathology	80299	CPT	3000089		Washington Regional Medical Center	outpatient	215	107.5	Humana	Medicare Advantage HMO/PPO/PFFS	101.05	8.76	161.25
DEXAMETHASONE	DEXAMETHASONE	Laboratory & Pathology	80299	CPT	3000089		Washington Regional Medical Center	outpatient	215	107.5	AmeriHealth Caritas North Carolina	NC Medicaid	24.97	8.76	161.25
DEXAMETHASONE	DEXAMETHASONE	Laboratory & Pathology	80299	CPT	3000089		Washington Regional Medical Center	outpatient	215	107.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	24.97	8.76	161.25
DEXAMETHASONE	DEXAMETHASONE	Laboratory & Pathology	80299	CPT	3000089		Washington Regional Medical Center	outpatient	215	107.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	24.97	8.76	161.25
DEXAMETHASONE	DEXAMETHASONE	Laboratory & Pathology	80299	CPT	3000089		Washington Regional Medical Center	outpatient	215	107.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	24.97	8.76	161.25
DEXAMETHASONE	DEXAMETHASONE	Laboratory & Pathology	80299	CPT	3000089		Washington Regional Medical Center	outpatient	215	107.5	Cigna	North Carolina PPO-PPA Direct	8.76	8.76	161.25
DEXAMETHASONE	DEXAMETHASONE	Laboratory & Pathology	80299	CPT	3000089		Washington Regional Medical Center	outpatient	215	107.5	Original Medicare	Traditional Medicare Fee-for-Service	101.05	8.76	161.25
DIGOXIN; TOTAL	DIGOXIN; TOTAL	Laboratory & Pathology	80162	CPT	3001017		Washington Regional Medical Center	outpatient	128	64	Self-Pay	Discounted Cash		8.59	96
DIGOXIN; TOTAL	DIGOXIN; TOTAL	Laboratory & Pathology	80162	CPT	3001017		Washington Regional Medical Center	outpatient	128	64	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	96	8.59	96
DIGOXIN; TOTAL	DIGOXIN; TOTAL	Laboratory & Pathology	80162	CPT	3001017		Washington Regional Medical Center	outpatient	128	64	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	56.32	8.59	96
DIGOXIN; TOTAL	DIGOXIN; TOTAL	Laboratory & Pathology	80162	CPT	3001017		Washington Regional Medical Center	outpatient	128	64	Humana	Medicare Advantage HMO/PPO/PFFS	60.16	8.59	96
DIGOXIN; TOTAL	DIGOXIN; TOTAL	Laboratory & Pathology	80162	CPT	3001017		Washington Regional Medical Center	outpatient	128	64	AmeriHealth Caritas North Carolina	NC Medicaid	24.21	8.59	96
DIGOXIN; TOTAL	DIGOXIN; TOTAL	Laboratory & Pathology	80162	CPT	3001017		Washington Regional Medical Center	outpatient	128	64	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	24.21	8.59	96
DIGOXIN; TOTAL	DIGOXIN; TOTAL	Laboratory & Pathology	80162	CPT	3001017		Washington Regional Medical Center	outpatient	128	64	WellCare of North Carolina	North Carolina Medicaid/CHIP	24.21	8.59	96
DIGOXIN; TOTAL	DIGOXIN; TOTAL	Laboratory & Pathology	80162	CPT	3001017		Washington Regional Medical Center	outpatient	128	64	Healthy Blue / Blue Cross NC	North Carolina Medicaid	24.21	8.59	96
DIGOXIN; TOTAL	DIGOXIN; TOTAL	Laboratory & Pathology	80162	CPT	3001017		Washington Regional Medical Center	outpatient	128	64	Cigna	North Carolina PPO-PPA Direct	8.59	8.59	96
DIGOXIN; TOTAL	DIGOXIN; TOTAL	Laboratory & Pathology	80162	CPT	3001017		Washington Regional Medical Center	outpatient	128	64	Original Medicare	Traditional Medicare Fee-for-Service	60.16	8.59	96
DILANTIN	DILANTIN	Laboratory & Pathology	80185	CPT	3001018		Washington Regional Medical Center	outpatient	150	75	Self-Pay	Discounted Cash		8.59	112.5
DILANTIN	DILANTIN	Laboratory & Pathology	80185	CPT	3001018		Washington Regional Medical Center	outpatient	150	75	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	112.5	8.59	112.5
DILANTIN	DILANTIN	Laboratory & Pathology	80185	CPT	3001018		Washington Regional Medical Center	outpatient	150	75	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	66	8.59	112.5
DILANTIN	DILANTIN	Laboratory & Pathology	80185	CPT	3001018		Washington Regional Medical Center	outpatient	150	75	Humana	Medicare Advantage HMO/PPO/PFFS	70.5	8.59	112.5
DILANTIN	DILANTIN	Laboratory & Pathology	80185	CPT	3001018		Washington Regional Medical Center	outpatient	150	75	AmeriHealth Caritas North Carolina	NC Medicaid	24.17	8.59	112.5
DILANTIN	DILANTIN	Laboratory & Pathology	80185	CPT	3001018		Washington Regional Medical Center	outpatient	150	75	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	24.17	8.59	112.5
DILANTIN	DILANTIN	Laboratory & Pathology	80185	CPT	3001018		Washington Regional Medical Center	outpatient	150	75	WellCare of North Carolina	North Carolina Medicaid/CHIP	24.17	8.59	112.5
DILANTIN	DILANTIN	Laboratory & Pathology	80185	CPT	3001018		Washington Regional Medical Center	outpatient	150	75	Healthy Blue / Blue Cross NC	North Carolina Medicaid	24.17	8.59	112.5
DILANTIN	DILANTIN	Laboratory & Pathology	80185	CPT	3001018		Washington Regional Medical Center	outpatient	150	75	Cigna	North Carolina PPO-PPA Direct	8.59	8.59	112.5
DILANTIN	DILANTIN	Laboratory & Pathology	80185	CPT	3001018		Washington Regional Medical Center	outpatient	150	75	Original Medicare	Traditional Medicare Fee-for-Service	70.5	8.59	112.5
EBV BY PCR	EBV BY PCR	Laboratory & Pathology	87799	CPT	3001641		Washington Regional Medical Center	outpatient	756	378	Self-Pay	Discounted Cash		27.69	567
EBV BY PCR	EBV BY PCR	Laboratory & Pathology	87799	CPT	3001641		Washington Regional Medical Center	outpatient	756	378	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	567	27.69	567
EBV BY PCR	EBV BY PCR	Laboratory & Pathology	87799	CPT	3001641		Washington Regional Medical Center	outpatient	756	378	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	332.64	27.69	567
EBV BY PCR	EBV BY PCR	Laboratory & Pathology	87799	CPT	3001641		Washington Regional Medical Center	outpatient	756	378	Humana	Medicare Advantage HMO/PPO/PFFS	355.32	27.69	567
EBV BY PCR	EBV BY PCR	Laboratory & Pathology	87799	CPT	3001641		Washington Regional Medical Center	outpatient	756	378	AmeriHealth Caritas North Carolina	NC Medicaid	59.4	27.69	567
EBV BY PCR	EBV BY PCR	Laboratory & Pathology	87799	CPT	3001641		Washington Regional Medical Center	outpatient	756	378	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	59.4	27.69	567
EBV BY PCR	EBV BY PCR	Laboratory & Pathology	87799	CPT	3001641		Washington Regional Medical Center	outpatient	756	378	WellCare of North Carolina	North Carolina Medicaid/CHIP	59.4	27.69	567
EBV BY PCR	EBV BY PCR	Laboratory & Pathology	87799	CPT	3001641		Washington Regional Medical Center	outpatient	756	378	Healthy Blue / Blue Cross NC	North Carolina Medicaid	59.4	27.69	567
EBV BY PCR	EBV BY PCR	Laboratory & Pathology	87799	CPT	3001641		Washington Regional Medical Center	outpatient	756	378	Cigna	North Carolina PPO-PPA Direct	27.69	27.69	567
EBV BY PCR	EBV BY PCR	Laboratory & Pathology	87799	CPT	3001641		Washington Regional Medical Center	outpatient	756	378	Original Medicare	Traditional Medicare Fee-for-Service	355.32	27.69	567
ELECTROLYTES PANEL	ELECTROLYTES PANEL	Laboratory & Pathology	80051	CPT	3002178		Washington Regional Medical Center	outpatient	140	70	Self-Pay	Discounted Cash		4.56	105
ELECTROLYTES PANEL	ELECTROLYTES PANEL	Laboratory & Pathology	80051	CPT	3002178		Washington Regional Medical Center	outpatient	140	70	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	105	4.56	105
ELECTROLYTES PANEL	ELECTROLYTES PANEL	Laboratory & Pathology	80051	CPT	3002178		Washington Regional Medical Center	outpatient	140	70	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	61.6	4.56	105
ELECTROLYTES PANEL	ELECTROLYTES PANEL	Laboratory & Pathology	80051	CPT	3002178		Washington Regional Medical Center	outpatient	140	70	Humana	Medicare Advantage HMO/PPO/PFFS	65.8	4.56	105
ELECTROLYTES PANEL	ELECTROLYTES PANEL	Laboratory & Pathology	80051	CPT	3002178		Washington Regional Medical Center	outpatient	140	70	AmeriHealth Caritas North Carolina	NC Medicaid	12.57	4.56	105
ELECTROLYTES PANEL	ELECTROLYTES PANEL	Laboratory & Pathology	80051	CPT	3002178		Washington Regional Medical Center	outpatient	140	70	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	12.57	4.56	105
ELECTROLYTES PANEL	ELECTROLYTES PANEL	Laboratory & Pathology	80051	CPT	3002178		Washington Regional Medical Center	outpatient	140	70	WellCare of North Carolina	North Carolina Medicaid/CHIP	12.57	4.56	105
ELECTROLYTES PANEL	ELECTROLYTES PANEL	Laboratory & Pathology	80051	CPT	3002178		Washington Regional Medical Center	outpatient	140	70	Healthy Blue / Blue Cross NC	North Carolina Medicaid	12.57	4.56	105
ELECTROLYTES PANEL	ELECTROLYTES PANEL	Laboratory & Pathology	80051	CPT	3002178		Washington Regional Medical Center	outpatient	140	70	Cigna	North Carolina PPO-PPA Direct	4.56	4.56	105
ELECTROLYTES PANEL	ELECTROLYTES PANEL	Laboratory & Pathology	80051	CPT	3002178		Washington Regional Medical Center	outpatient	140	70	Original Medicare	Traditional Medicare Fee-for-Service	65.8	4.56	105
EPSTEIN-BAR (EBV) QUANT (PCR)	EPSTEIN-BAR (EBV) QUANT (PCR)	Laboratory & Pathology	87480	CPT	3002038		Washington Regional Medical Center	outpatient	171.36	85.68	Self-Pay	Discounted Cash		12.97	128.52
EPSTEIN-BAR (EBV) QUANT (PCR)	EPSTEIN-BAR (EBV) QUANT (PCR)	Laboratory & Pathology	87480	CPT	3002038		Washington Regional Medical Center	outpatient	171.36	85.68	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	128.52	12.97	128.52
EPSTEIN-BAR (EBV) QUANT (PCR)	EPSTEIN-BAR (EBV) QUANT (PCR)	Laboratory & Pathology	87480	CPT	3002038		Washington Regional Medical Center	outpatient	171.36	85.68	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	75.4	12.97	128.52
EPSTEIN-BAR (EBV) QUANT (PCR)	EPSTEIN-BAR (EBV) QUANT (PCR)	Laboratory & Pathology	87480	CPT	3002038		Washington Regional Medical Center	outpatient	171.36	85.68	Humana	Medicare Advantage HMO/PPO/PFFS	80.54	12.97	128.52
EPSTEIN-BAR (EBV) QUANT (PCR)	EPSTEIN-BAR (EBV) QUANT (PCR)	Laboratory & Pathology	87480	CPT	3002038		Washington Regional Medical Center	outpatient	171.36	85.68	AmeriHealth Caritas North Carolina	NC Medicaid	36.58	12.97	128.52
EPSTEIN-BAR (EBV) QUANT (PCR)	EPSTEIN-BAR (EBV) QUANT (PCR)	Laboratory & Pathology	87480	CPT	3002038		Washington Regional Medical Center	outpatient	171.36	85.68	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	36.58	12.97	128.52
EPSTEIN-BAR (EBV) QUANT (PCR)	EPSTEIN-BAR (EBV) QUANT (PCR)	Laboratory & Pathology	87480	CPT	3002038		Washington Regional Medical Center	outpatient	171.36	85.68	WellCare of North Carolina	North Carolina Medicaid/CHIP	36.58	12.97	128.52
EPSTEIN-BAR (EBV) QUANT (PCR)	EPSTEIN-BAR (EBV) QUANT (PCR)	Laboratory & Pathology	87480	CPT	3002038		Washington Regional Medical Center	outpatient	171.36	85.68	Healthy Blue / Blue Cross NC	North Carolina Medicaid	36.58	12.97	128.52
EPSTEIN-BAR (EBV) QUANT (PCR)	EPSTEIN-BAR (EBV) QUANT (PCR)	Laboratory & Pathology	87480	CPT	3002038		Washington Regional Medical Center	outpatient	171.36	85.68	Cigna	North Carolina PPO-PPA Direct	12.97	12.97	128.52
EPSTEIN-BAR (EBV) QUANT (PCR)	EPSTEIN-BAR (EBV) QUANT (PCR)	Laboratory & Pathology	87480	CPT	3002038		Washington Regional Medical Center	outpatient	171.36	85.68	Original Medicare	Traditional Medicare Fee-for-Service	80.54	12.97	128.52
ESTRADIOL	ESTRADIOL	Laboratory & Pathology	82670	CPT	3001159		Washington Regional Medical Center	outpatient	190	95	Self-Pay	Discounted Cash		18.05	142.5
ESTRADIOL	ESTRADIOL	Laboratory & Pathology	82670	CPT	3001159		Washington Regional Medical Center	outpatient	190	95	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	142.5	18.05	142.5
ESTRADIOL	ESTRADIOL	Laboratory & Pathology	82670	CPT	3001159		Washington Regional Medical Center	outpatient	190	95	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	83.6	18.05	142.5
ESTRADIOL	ESTRADIOL	Laboratory & Pathology	82670	CPT	3001159		Washington Regional Medical Center	outpatient	190	95	Humana	Medicare Advantage HMO/PPO/PFFS	89.3	18.05	142.5
ESTRADIOL	ESTRADIOL	Laboratory & Pathology	82670	CPT	3001159		Washington Regional Medical Center	outpatient	190	95	AmeriHealth Caritas North Carolina	NC Medicaid	43.43	18.05	142.5
ESTRADIOL	ESTRADIOL	Laboratory & Pathology	82670	CPT	3001159		Washington Regional Medical Center	outpatient	190	95	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	43.43	18.05	142.5
ESTRADIOL	ESTRADIOL	Laboratory & Pathology	82670	CPT	3001159		Washington Regional Medical Center	outpatient	190	95	WellCare of North Carolina	North Carolina Medicaid/CHIP	43.43	18.05	142.5
ESTRADIOL	ESTRADIOL	Laboratory & Pathology	82670	CPT	3001159		Washington Regional Medical Center	outpatient	190	95	Healthy Blue / Blue Cross NC	North Carolina Medicaid	43.43	18.05	142.5
ESTRADIOL	ESTRADIOL	Laboratory & Pathology	82670	CPT	3001159		Washington Regional Medical Center	outpatient	190	95	Cigna	North Carolina PPO-PPA Direct	18.05	18.05	142.5
ESTRADIOL	ESTRADIOL	Laboratory & Pathology	82670	CPT	3001159		Washington Regional Medical Center	outpatient	190	95	Original Medicare	Traditional Medicare Fee-for-Service	89.3	18.05	142.5
F2 GENE 20210G>A VARIANT	F2 GENE 20210G>A VARIANT	Laboratory & Pathology	81240	CPT	3002523		Washington Regional Medical Center	outpatient	726	363	Self-Pay	Discounted Cash		89.29	544.5
F2 GENE 20210G>A VARIANT	F2 GENE 20210G>A VARIANT	Laboratory & Pathology	81240	CPT	3002523		Washington Regional Medical Center	outpatient	726	363	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	544.5	89.29	544.5
F2 GENE 20210G>A VARIANT	F2 GENE 20210G>A VARIANT	Laboratory & Pathology	81240	CPT	3002523		Washington Regional Medical Center	outpatient	726	363	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	319.44	89.29	544.5
F2 GENE 20210G>A VARIANT	F2 GENE 20210G>A VARIANT	Laboratory & Pathology	81240	CPT	3002523		Washington Regional Medical Center	outpatient	726	363	Humana	Medicare Advantage HMO/PPO/PFFS	341.22	89.29	544.5
F2 GENE 20210G>A VARIANT	F2 GENE 20210G>A VARIANT	Laboratory & Pathology	81240	CPT	3002523		Washington Regional Medical Center	outpatient	726	363	AmeriHealth Caritas North Carolina	NC Medicaid	89.29	89.29	544.5
F2 GENE 20210G>A VARIANT	F2 GENE 20210G>A VARIANT	Laboratory & Pathology	81240	CPT	3002523		Washington Regional Medical Center	outpatient	726	363	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	89.29	89.29	544.5
F2 GENE 20210G>A VARIANT	F2 GENE 20210G>A VARIANT	Laboratory & Pathology	81240	CPT	3002523		Washington Regional Medical Center	outpatient	726	363	WellCare of North Carolina	North Carolina Medicaid/CHIP	89.29	89.29	544.5
F2 GENE 20210G>A VARIANT	F2 GENE 20210G>A VARIANT	Laboratory & Pathology	81240	CPT	3002523		Washington Regional Medical Center	outpatient	726	363	Healthy Blue / Blue Cross NC	North Carolina Medicaid	89.29	89.29	544.5
F2 GENE 20210G>A VARIANT	F2 GENE 20210G>A VARIANT	Laboratory & Pathology	81240	CPT	3002523		Washington Regional Medical Center	outpatient	726	363	Original Medicare	Traditional Medicare Fee-for-Service	341.22	89.29	544.5
GABAPENTIN WHOLE BLOOD, SERUM,	GABAPENTIN WHOLE BLOOD, SERUM,	Laboratory & Pathology	80171	CPT	3001778		Washington Regional Medical Center	outpatient	206	103	Self-Pay	Discounted Cash		8.76	154.5
GABAPENTIN WHOLE BLOOD, SERUM,	GABAPENTIN WHOLE BLOOD, SERUM,	Laboratory & Pathology	80171	CPT	3001778		Washington Regional Medical Center	outpatient	206	103	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	154.5	8.76	154.5
GABAPENTIN WHOLE BLOOD, SERUM,	GABAPENTIN WHOLE BLOOD, SERUM,	Laboratory & Pathology	80171	CPT	3001778		Washington Regional Medical Center	outpatient	206	103	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	90.64	8.76	154.5
GABAPENTIN WHOLE BLOOD, SERUM,	GABAPENTIN WHOLE BLOOD, SERUM,	Laboratory & Pathology	80171	CPT	3001778		Washington Regional Medical Center	outpatient	206	103	Humana	Medicare Advantage HMO/PPO/PFFS	96.82	8.76	154.5
GABAPENTIN WHOLE BLOOD, SERUM,	GABAPENTIN WHOLE BLOOD, SERUM,	Laboratory & Pathology	80171	CPT	3001778		Washington Regional Medical Center	outpatient	206	103	AmeriHealth Caritas North Carolina	NC Medicaid	23.61	8.76	154.5
GABAPENTIN WHOLE BLOOD, SERUM,	GABAPENTIN WHOLE BLOOD, SERUM,	Laboratory & Pathology	80171	CPT	3001778		Washington Regional Medical Center	outpatient	206	103	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	23.61	8.76	154.5
GABAPENTIN WHOLE BLOOD, SERUM,	GABAPENTIN WHOLE BLOOD, SERUM,	Laboratory & Pathology	80171	CPT	3001778		Washington Regional Medical Center	outpatient	206	103	WellCare of North Carolina	North Carolina Medicaid/CHIP	23.61	8.76	154.5
GABAPENTIN WHOLE BLOOD, SERUM,	GABAPENTIN WHOLE BLOOD, SERUM,	Laboratory & Pathology	80171	CPT	3001778		Washington Regional Medical Center	outpatient	206	103	Healthy Blue / Blue Cross NC	North Carolina Medicaid	23.61	8.76	154.5
GABAPENTIN WHOLE BLOOD, SERUM,	GABAPENTIN WHOLE BLOOD, SERUM,	Laboratory & Pathology	80171	CPT	3001778		Washington Regional Medical Center	outpatient	206	103	Cigna	North Carolina PPO-PPA Direct	8.76	8.76	154.5
GABAPENTIN WHOLE BLOOD, SERUM,	GABAPENTIN WHOLE BLOOD, SERUM,	Laboratory & Pathology	80171	CPT	3001778		Washington Regional Medical Center	outpatient	206	103	Original Medicare	Traditional Medicare Fee-for-Service	96.82	8.76	154.5
GASTRIN, SERUM	GASTRIN, SERUM	Laboratory & Pathology	82941	CPT	3001480		Washington Regional Medical Center	outpatient	145	72.5	Self-Pay	Discounted Cash		11.39	108.75
GASTRIN, SERUM	GASTRIN, SERUM	Laboratory & Pathology	82941	CPT	3001480		Washington Regional Medical Center	outpatient	145	72.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	108.75	11.39	108.75
GASTRIN, SERUM	GASTRIN, SERUM	Laboratory & Pathology	82941	CPT	3001480		Washington Regional Medical Center	outpatient	145	72.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	63.8	11.39	108.75
GASTRIN, SERUM	GASTRIN, SERUM	Laboratory & Pathology	82941	CPT	3001480		Washington Regional Medical Center	outpatient	145	72.5	Humana	Medicare Advantage HMO/PPO/PFFS	68.15	11.39	108.75
GASTRIN, SERUM	GASTRIN, SERUM	Laboratory & Pathology	82941	CPT	3001480		Washington Regional Medical Center	outpatient	145	72.5	AmeriHealth Caritas North Carolina	NC Medicaid	32.16	11.39	108.75
GASTRIN, SERUM	GASTRIN, SERUM	Laboratory & Pathology	82941	CPT	3001480		Washington Regional Medical Center	outpatient	145	72.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	32.16	11.39	108.75
GASTRIN, SERUM	GASTRIN, SERUM	Laboratory & Pathology	82941	CPT	3001480		Washington Regional Medical Center	outpatient	145	72.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	32.16	11.39	108.75
GASTRIN, SERUM	GASTRIN, SERUM	Laboratory & Pathology	82941	CPT	3001480		Washington Regional Medical Center	outpatient	145	72.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	32.16	11.39	108.75
GASTRIN, SERUM	GASTRIN, SERUM	Laboratory & Pathology	82941	CPT	3001480		Washington Regional Medical Center	outpatient	145	72.5	Cigna	North Carolina PPO-PPA Direct	11.39	11.39	108.75
GASTRIN, SERUM	GASTRIN, SERUM	Laboratory & Pathology	82941	CPT	3001480		Washington Regional Medical Center	outpatient	145	72.5	Original Medicare	Traditional Medicare Fee-for-Service	68.15	11.39	108.75
GENTAMICIN	GENTAMICIN	Laboratory & Pathology	80170	CPT	3001074		Washington Regional Medical Center	outpatient	155	77.5	Self-Pay	Discounted Cash		6.31	116.25
GENTAMICIN	GENTAMICIN	Laboratory & Pathology	80170	CPT	3001074		Washington Regional Medical Center	outpatient	155	77.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	116.25	6.31	116.25
GENTAMICIN	GENTAMICIN	Laboratory & Pathology	80170	CPT	3001074		Washington Regional Medical Center	outpatient	155	77.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	68.2	6.31	116.25
GENTAMICIN	GENTAMICIN	Laboratory & Pathology	80170	CPT	3001074		Washington Regional Medical Center	outpatient	155	77.5	Humana	Medicare Advantage HMO/PPO/PFFS	72.85	6.31	116.25
GENTAMICIN	GENTAMICIN	Laboratory & Pathology	80170	CPT	3001074		Washington Regional Medical Center	outpatient	155	77.5	AmeriHealth Caritas North Carolina	NC Medicaid	6.31	6.31	116.25
GENTAMICIN	GENTAMICIN	Laboratory & Pathology	80170	CPT	3001074		Washington Regional Medical Center	outpatient	155	77.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	6.31	6.31	116.25
GENTAMICIN	GENTAMICIN	Laboratory & Pathology	80170	CPT	3001074		Washington Regional Medical Center	outpatient	155	77.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	6.31	6.31	116.25
GENTAMICIN	GENTAMICIN	Laboratory & Pathology	80170	CPT	3001074		Washington Regional Medical Center	outpatient	155	77.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	6.31	6.31	116.25
GENTAMICIN	GENTAMICIN	Laboratory & Pathology	80170	CPT	3001074		Washington Regional Medical Center	outpatient	155	77.5	Cigna	North Carolina PPO-PPA Direct	10.52	6.31	116.25
GENTAMICIN	GENTAMICIN	Laboratory & Pathology	80170	CPT	3001074		Washington Regional Medical Center	outpatient	155	77.5	Original Medicare	Traditional Medicare Fee-for-Service	72.85	6.31	116.25
GLUCOSE POST INCLUD	GLUCOSE POST INCLUD	Laboratory & Pathology	82951	CPT	3001090		Washington Regional Medical Center	outpatient	19	9.5	Self-Pay	Discounted Cash		8.36	23.48
GLUCOSE POST INCLUD	GLUCOSE POST INCLUD	Laboratory & Pathology	82951	CPT	3001090		Washington Regional Medical Center	outpatient	19	9.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	14.25	8.36	23.48
GLUCOSE POST INCLUD	GLUCOSE POST INCLUD	Laboratory & Pathology	82951	CPT	3001090		Washington Regional Medical Center	outpatient	19	9.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	8.36	8.36	23.48
GLUCOSE POST INCLUD	GLUCOSE POST INCLUD	Laboratory & Pathology	82951	CPT	3001090		Washington Regional Medical Center	outpatient	19	9.5	Humana	Medicare Advantage HMO/PPO/PFFS	8.93	8.36	23.48
GLUCOSE POST INCLUD	GLUCOSE POST INCLUD	Laboratory & Pathology	82951	CPT	3001090		Washington Regional Medical Center	outpatient	19	9.5	AmeriHealth Caritas North Carolina	NC Medicaid	23.48	8.36	23.48
GLUCOSE POST INCLUD	GLUCOSE POST INCLUD	Laboratory & Pathology	82951	CPT	3001090		Washington Regional Medical Center	outpatient	19	9.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	23.48	8.36	23.48
GLUCOSE POST INCLUD	GLUCOSE POST INCLUD	Laboratory & Pathology	82951	CPT	3001090		Washington Regional Medical Center	outpatient	19	9.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	23.48	8.36	23.48
GLUCOSE POST INCLUD	GLUCOSE POST INCLUD	Laboratory & Pathology	82951	CPT	3001090		Washington Regional Medical Center	outpatient	19	9.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	23.48	8.36	23.48
GLUCOSE POST INCLUD	GLUCOSE POST INCLUD	Laboratory & Pathology	82951	CPT	3001090		Washington Regional Medical Center	outpatient	19	9.5	Cigna	North Carolina PPO-PPA Direct	13.18	8.36	23.48
GLUCOSE POST INCLUD	GLUCOSE POST INCLUD	Laboratory & Pathology	82951	CPT	3001090		Washington Regional Medical Center	outpatient	19	9.5	Original Medicare	Traditional Medicare Fee-for-Service	8.93	8.36	23.48
GROWTH HORMONE	GROWTH HORMONE	Laboratory & Pathology	83003	CPT	3001367		Washington Regional Medical Center	outpatient	95	47.5	Self-Pay	Discounted Cash		10.69	71.25
GROWTH HORMONE	GROWTH HORMONE	Laboratory & Pathology	83003	CPT	3001367		Washington Regional Medical Center	outpatient	95	47.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	71.25	10.69	71.25
GROWTH HORMONE	GROWTH HORMONE	Laboratory & Pathology	83003	CPT	3001367		Washington Regional Medical Center	outpatient	95	47.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	41.8	10.69	71.25
GROWTH HORMONE	GROWTH HORMONE	Laboratory & Pathology	83003	CPT	3001367		Washington Regional Medical Center	outpatient	95	47.5	Humana	Medicare Advantage HMO/PPO/PFFS	44.65	10.69	71.25
GROWTH HORMONE	GROWTH HORMONE	Laboratory & Pathology	83003	CPT	3001367		Washington Regional Medical Center	outpatient	95	47.5	AmeriHealth Caritas North Carolina	NC Medicaid	30.4	10.69	71.25
GROWTH HORMONE	GROWTH HORMONE	Laboratory & Pathology	83003	CPT	3001367		Washington Regional Medical Center	outpatient	95	47.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	30.4	10.69	71.25
GROWTH HORMONE	GROWTH HORMONE	Laboratory & Pathology	83003	CPT	3001367		Washington Regional Medical Center	outpatient	95	47.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	30.4	10.69	71.25
GROWTH HORMONE	GROWTH HORMONE	Laboratory & Pathology	83003	CPT	3001367		Washington Regional Medical Center	outpatient	95	47.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	30.4	10.69	71.25
GROWTH HORMONE	GROWTH HORMONE	Laboratory & Pathology	83003	CPT	3001367		Washington Regional Medical Center	outpatient	95	47.5	Cigna	North Carolina PPO-PPA Direct	10.69	10.69	71.25
GROWTH HORMONE	GROWTH HORMONE	Laboratory & Pathology	83003	CPT	3001367		Washington Regional Medical Center	outpatient	95	47.5	Original Medicare	Traditional Medicare Fee-for-Service	44.65	10.69	71.25
GTT: EA. ADD. SPECI.	GTT: EA. ADD. SPECI.	Laboratory & Pathology	82951	CPT	3001089		Washington Regional Medical Center	outpatient	15.68	7.84	Self-Pay	Discounted Cash		6.9	23.48
GTT: EA. ADD. SPECI.	GTT: EA. ADD. SPECI.	Laboratory & Pathology	82951	CPT	3001089		Washington Regional Medical Center	outpatient	15.68	7.84	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	11.76	6.9	23.48
GTT: EA. ADD. SPECI.	GTT: EA. ADD. SPECI.	Laboratory & Pathology	82951	CPT	3001089		Washington Regional Medical Center	outpatient	15.68	7.84	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	6.9	6.9	23.48
GTT: EA. ADD. SPECI.	GTT: EA. ADD. SPECI.	Laboratory & Pathology	82951	CPT	3001089		Washington Regional Medical Center	outpatient	15.68	7.84	Humana	Medicare Advantage HMO/PPO/PFFS	7.37	6.9	23.48
GTT: EA. ADD. SPECI.	GTT: EA. ADD. SPECI.	Laboratory & Pathology	82951	CPT	3001089		Washington Regional Medical Center	outpatient	15.68	7.84	AmeriHealth Caritas North Carolina	NC Medicaid	23.48	6.9	23.48
GTT: EA. ADD. SPECI.	GTT: EA. ADD. SPECI.	Laboratory & Pathology	82951	CPT	3001089		Washington Regional Medical Center	outpatient	15.68	7.84	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	23.48	6.9	23.48
GTT: EA. ADD. SPECI.	GTT: EA. ADD. SPECI.	Laboratory & Pathology	82951	CPT	3001089		Washington Regional Medical Center	outpatient	15.68	7.84	WellCare of North Carolina	North Carolina Medicaid/CHIP	23.48	6.9	23.48
GTT: EA. ADD. SPECI.	GTT: EA. ADD. SPECI.	Laboratory & Pathology	82951	CPT	3001089		Washington Regional Medical Center	outpatient	15.68	7.84	Healthy Blue / Blue Cross NC	North Carolina Medicaid	23.48	6.9	23.48
GTT: EA. ADD. SPECI.	GTT: EA. ADD. SPECI.	Laboratory & Pathology	82951	CPT	3001089		Washington Regional Medical Center	outpatient	15.68	7.84	Cigna	North Carolina PPO-PPA Direct	13.18	6.9	23.48
GTT: EA. ADD. SPECI.	GTT: EA. ADD. SPECI.	Laboratory & Pathology	82951	CPT	3001089		Washington Regional Medical Center	outpatient	15.68	7.84	Original Medicare	Traditional Medicare Fee-for-Service	7.37	6.9	23.48
H. PYLORI IGG, ABS	H. PYLORI IGG, ABS	Laboratory & Pathology	86677	CPT	3002374		Washington Regional Medical Center	outpatient	170	85	Self-Pay	Discounted Cash		9.46	127.5
H. PYLORI IGG, ABS	H. PYLORI IGG, ABS	Laboratory & Pathology	86677	CPT	3002374		Washington Regional Medical Center	outpatient	170	85	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	127.5	9.46	127.5
H. PYLORI IGG, ABS	H. PYLORI IGG, ABS	Laboratory & Pathology	86677	CPT	3002374		Washington Regional Medical Center	outpatient	170	85	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	74.8	9.46	127.5
H. PYLORI IGG, ABS	H. PYLORI IGG, ABS	Laboratory & Pathology	86677	CPT	3002374		Washington Regional Medical Center	outpatient	170	85	Humana	Medicare Advantage HMO/PPO/PFFS	79.9	9.46	127.5
H. PYLORI IGG, ABS	H. PYLORI IGG, ABS	Laboratory & Pathology	86677	CPT	3002374		Washington Regional Medical Center	outpatient	170	85	AmeriHealth Caritas North Carolina	NC Medicaid	26.47	9.46	127.5
H. PYLORI IGG, ABS	H. PYLORI IGG, ABS	Laboratory & Pathology	86677	CPT	3002374		Washington Regional Medical Center	outpatient	170	85	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	26.47	9.46	127.5
H. PYLORI IGG, ABS	H. PYLORI IGG, ABS	Laboratory & Pathology	86677	CPT	3002374		Washington Regional Medical Center	outpatient	170	85	WellCare of North Carolina	North Carolina Medicaid/CHIP	26.47	9.46	127.5
H. PYLORI IGG, ABS	H. PYLORI IGG, ABS	Laboratory & Pathology	86677	CPT	3002374		Washington Regional Medical Center	outpatient	170	85	Healthy Blue / Blue Cross NC	North Carolina Medicaid	26.47	9.46	127.5
H. PYLORI IGG, ABS	H. PYLORI IGG, ABS	Laboratory & Pathology	86677	CPT	3002374		Washington Regional Medical Center	outpatient	170	85	Cigna	North Carolina PPO-PPA Direct	9.46	9.46	127.5
H. PYLORI IGG, ABS	H. PYLORI IGG, ABS	Laboratory & Pathology	86677	CPT	3002374		Washington Regional Medical Center	outpatient	170	85	Original Medicare	Traditional Medicare Fee-for-Service	79.9	9.46	127.5
H. PYLORI, IGM/G,A AB	H. PYLORI, IGM/G,A AB	Laboratory & Pathology	86677	CPT	3002381		Washington Regional Medical Center	outpatient	170	85	Self-Pay	Discounted Cash		9.46	127.5
H. PYLORI, IGM/G,A AB	H. PYLORI, IGM/G,A AB	Laboratory & Pathology	86677	CPT	3002381		Washington Regional Medical Center	outpatient	170	85	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	127.5	9.46	127.5
H. PYLORI, IGM/G,A AB	H. PYLORI, IGM/G,A AB	Laboratory & Pathology	86677	CPT	3002381		Washington Regional Medical Center	outpatient	170	85	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	74.8	9.46	127.5
H. PYLORI, IGM/G,A AB	H. PYLORI, IGM/G,A AB	Laboratory & Pathology	86677	CPT	3002381		Washington Regional Medical Center	outpatient	170	85	Humana	Medicare Advantage HMO/PPO/PFFS	79.9	9.46	127.5
H. PYLORI, IGM/G,A AB	H. PYLORI, IGM/G,A AB	Laboratory & Pathology	86677	CPT	3002381		Washington Regional Medical Center	outpatient	170	85	AmeriHealth Caritas North Carolina	NC Medicaid	26.47	9.46	127.5
H. PYLORI, IGM/G,A AB	H. PYLORI, IGM/G,A AB	Laboratory & Pathology	86677	CPT	3002381		Washington Regional Medical Center	outpatient	170	85	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	26.47	9.46	127.5
H. PYLORI, IGM/G,A AB	H. PYLORI, IGM/G,A AB	Laboratory & Pathology	86677	CPT	3002381		Washington Regional Medical Center	outpatient	170	85	WellCare of North Carolina	North Carolina Medicaid/CHIP	26.47	9.46	127.5
H. PYLORI, IGM/G,A AB	H. PYLORI, IGM/G,A AB	Laboratory & Pathology	86677	CPT	3002381		Washington Regional Medical Center	outpatient	170	85	Healthy Blue / Blue Cross NC	North Carolina Medicaid	26.47	9.46	127.5
H. PYLORI, IGM/G,A AB	H. PYLORI, IGM/G,A AB	Laboratory & Pathology	86677	CPT	3002381		Washington Regional Medical Center	outpatient	170	85	Cigna	North Carolina PPO-PPA Direct	9.46	9.46	127.5
H. PYLORI, IGM/G,A AB	H. PYLORI, IGM/G,A AB	Laboratory & Pathology	86677	CPT	3002381		Washington Regional Medical Center	outpatient	170	85	Original Medicare	Traditional Medicare Fee-for-Service	79.9	9.46	127.5
HCV RNA PCR	HCV RNA PCR	Laboratory & Pathology	87522	CPT	3002375		Washington Regional Medical Center	outpatient	450	225	Self-Pay	Discounted Cash		27.69	337.5
HCV RNA PCR	HCV RNA PCR	Laboratory & Pathology	87522	CPT	3002375		Washington Regional Medical Center	outpatient	450	225	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	337.5	27.69	337.5
HCV RNA PCR	HCV RNA PCR	Laboratory & Pathology	87522	CPT	3002375		Washington Regional Medical Center	outpatient	450	225	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	198	27.69	337.5
HCV RNA PCR	HCV RNA PCR	Laboratory & Pathology	87522	CPT	3002375		Washington Regional Medical Center	outpatient	450	225	Humana	Medicare Advantage HMO/PPO/PFFS	211.5	27.69	337.5
HCV RNA PCR	HCV RNA PCR	Laboratory & Pathology	87522	CPT	3002375		Washington Regional Medical Center	outpatient	450	225	AmeriHealth Caritas North Carolina	NC Medicaid	59.4	27.69	337.5
HCV RNA PCR	HCV RNA PCR	Laboratory & Pathology	87522	CPT	3002375		Washington Regional Medical Center	outpatient	450	225	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	59.4	27.69	337.5
HCV RNA PCR	HCV RNA PCR	Laboratory & Pathology	87522	CPT	3002375		Washington Regional Medical Center	outpatient	450	225	WellCare of North Carolina	North Carolina Medicaid/CHIP	59.4	27.69	337.5
HCV RNA PCR	HCV RNA PCR	Laboratory & Pathology	87522	CPT	3002375		Washington Regional Medical Center	outpatient	450	225	Healthy Blue / Blue Cross NC	North Carolina Medicaid	59.4	27.69	337.5
HCV RNA PCR	HCV RNA PCR	Laboratory & Pathology	87522	CPT	3002375		Washington Regional Medical Center	outpatient	450	225	Cigna	North Carolina PPO-PPA Direct	27.69	27.69	337.5
HCV RNA PCR	HCV RNA PCR	Laboratory & Pathology	87522	CPT	3002375		Washington Regional Medical Center	outpatient	450	225	Original Medicare	Traditional Medicare Fee-for-Service	211.5	27.69	337.5
HEP B CORE Ab TOTAL	HEP B CORE Ab TOTAL	Laboratory & Pathology	86704	CPT	3001371		Washington Regional Medical Center	outpatient	115	57.5	Self-Pay	Discounted Cash		7.71	86.25
HEP B CORE Ab TOTAL	HEP B CORE Ab TOTAL	Laboratory & Pathology	86704	CPT	3001371		Washington Regional Medical Center	outpatient	115	57.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	86.25	7.71	86.25
HEP B CORE Ab TOTAL	HEP B CORE Ab TOTAL	Laboratory & Pathology	86704	CPT	3001371		Washington Regional Medical Center	outpatient	115	57.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	50.6	7.71	86.25
HEP B CORE Ab TOTAL	HEP B CORE Ab TOTAL	Laboratory & Pathology	86704	CPT	3001371		Washington Regional Medical Center	outpatient	115	57.5	Humana	Medicare Advantage HMO/PPO/PFFS	54.05	7.71	86.25
HEP B CORE Ab TOTAL	HEP B CORE Ab TOTAL	Laboratory & Pathology	86704	CPT	3001371		Washington Regional Medical Center	outpatient	115	57.5	AmeriHealth Caritas North Carolina	NC Medicaid	21.23	7.71	86.25
HEP B CORE Ab TOTAL	HEP B CORE Ab TOTAL	Laboratory & Pathology	86704	CPT	3001371		Washington Regional Medical Center	outpatient	115	57.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	21.23	7.71	86.25
HEP B CORE Ab TOTAL	HEP B CORE Ab TOTAL	Laboratory & Pathology	86704	CPT	3001371		Washington Regional Medical Center	outpatient	115	57.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	21.23	7.71	86.25
HEP B CORE Ab TOTAL	HEP B CORE Ab TOTAL	Laboratory & Pathology	86704	CPT	3001371		Washington Regional Medical Center	outpatient	115	57.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	21.23	7.71	86.25
HEP B CORE Ab TOTAL	HEP B CORE Ab TOTAL	Laboratory & Pathology	86704	CPT	3001371		Washington Regional Medical Center	outpatient	115	57.5	Cigna	North Carolina PPO-PPA Direct	7.71	7.71	86.25
HEP B CORE Ab TOTAL	HEP B CORE Ab TOTAL	Laboratory & Pathology	86704	CPT	3001371		Washington Regional Medical Center	outpatient	115	57.5	Original Medicare	Traditional Medicare Fee-for-Service	54.05	7.71	86.25
HEPATITIS B DNA AMP PROBE	HEPATITIS B DNA AMP PROBE	Laboratory & Pathology	87522	CPT	3001377		Washington Regional Medical Center	outpatient	140.36	70.18	Self-Pay	Discounted Cash		27.69	105.27
HEPATITIS B DNA AMP PROBE	HEPATITIS B DNA AMP PROBE	Laboratory & Pathology	87522	CPT	3001377		Washington Regional Medical Center	outpatient	140.36	70.18	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	105.27	27.69	105.27
HEPATITIS B DNA AMP PROBE	HEPATITIS B DNA AMP PROBE	Laboratory & Pathology	87522	CPT	3001377		Washington Regional Medical Center	outpatient	140.36	70.18	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	61.76	27.69	105.27
HEPATITIS B DNA AMP PROBE	HEPATITIS B DNA AMP PROBE	Laboratory & Pathology	87522	CPT	3001377		Washington Regional Medical Center	outpatient	140.36	70.18	Humana	Medicare Advantage HMO/PPO/PFFS	65.97	27.69	105.27
HEPATITIS B DNA AMP PROBE	HEPATITIS B DNA AMP PROBE	Laboratory & Pathology	87522	CPT	3001377		Washington Regional Medical Center	outpatient	140.36	70.18	AmeriHealth Caritas North Carolina	NC Medicaid	59.4	27.69	105.27
HEPATITIS B DNA AMP PROBE	HEPATITIS B DNA AMP PROBE	Laboratory & Pathology	87522	CPT	3001377		Washington Regional Medical Center	outpatient	140.36	70.18	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	59.4	27.69	105.27
HEPATITIS B DNA AMP PROBE	HEPATITIS B DNA AMP PROBE	Laboratory & Pathology	87522	CPT	3001377		Washington Regional Medical Center	outpatient	140.36	70.18	WellCare of North Carolina	North Carolina Medicaid/CHIP	59.4	27.69	105.27
HEPATITIS B DNA AMP PROBE	HEPATITIS B DNA AMP PROBE	Laboratory & Pathology	87522	CPT	3001377		Washington Regional Medical Center	outpatient	140.36	70.18	Healthy Blue / Blue Cross NC	North Carolina Medicaid	59.4	27.69	105.27
HEPATITIS B DNA AMP PROBE	HEPATITIS B DNA AMP PROBE	Laboratory & Pathology	87522	CPT	3001377		Washington Regional Medical Center	outpatient	140.36	70.18	Cigna	North Carolina PPO-PPA Direct	27.69	27.69	105.27
HEPATITIS B DNA AMP PROBE	HEPATITIS B DNA AMP PROBE	Laboratory & Pathology	87522	CPT	3001377		Washington Regional Medical Center	outpatient	140.36	70.18	Original Medicare	Traditional Medicare Fee-for-Service	65.97	27.69	105.27
HEPATITIS B SURFACE AG	HEPATITIS B SURFACE AG	Laboratory & Pathology	87340	CPT	3001368		Washington Regional Medical Center	outpatient	107	53.5	Self-Pay	Discounted Cash		6.66	80.25
HEPATITIS B SURFACE AG	HEPATITIS B SURFACE AG	Laboratory & Pathology	87340	CPT	3001368		Washington Regional Medical Center	outpatient	107	53.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	80.25	6.66	80.25
HEPATITIS B SURFACE AG	HEPATITIS B SURFACE AG	Laboratory & Pathology	87340	CPT	3001368		Washington Regional Medical Center	outpatient	107	53.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	47.08	6.66	80.25
HEPATITIS B SURFACE AG	HEPATITIS B SURFACE AG	Laboratory & Pathology	87340	CPT	3001368		Washington Regional Medical Center	outpatient	107	53.5	Humana	Medicare Advantage HMO/PPO/PFFS	50.29	6.66	80.25
HEPATITIS B SURFACE AG	HEPATITIS B SURFACE AG	Laboratory & Pathology	87340	CPT	3001368		Washington Regional Medical Center	outpatient	107	53.5	AmeriHealth Caritas North Carolina	NC Medicaid	16.97	6.66	80.25
HEPATITIS B SURFACE AG	HEPATITIS B SURFACE AG	Laboratory & Pathology	87340	CPT	3001368		Washington Regional Medical Center	outpatient	107	53.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	16.97	6.66	80.25
HEPATITIS B SURFACE AG	HEPATITIS B SURFACE AG	Laboratory & Pathology	87340	CPT	3001368		Washington Regional Medical Center	outpatient	107	53.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	16.97	6.66	80.25
HEPATITIS B SURFACE AG	HEPATITIS B SURFACE AG	Laboratory & Pathology	87340	CPT	3001368		Washington Regional Medical Center	outpatient	107	53.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	16.97	6.66	80.25
HEPATITIS B SURFACE AG	HEPATITIS B SURFACE AG	Laboratory & Pathology	87340	CPT	3001368		Washington Regional Medical Center	outpatient	107	53.5	Cigna	North Carolina PPO-PPA Direct	6.66	6.66	80.25
HEPATITIS B SURFACE AG	HEPATITIS B SURFACE AG	Laboratory & Pathology	87340	CPT	3001368		Washington Regional Medical Center	outpatient	107	53.5	Original Medicare	Traditional Medicare Fee-for-Service	50.29	6.66	80.25
HEPATITIS PANEL ACUTE	HEPATITIS PANEL ACUTE	Laboratory & Pathology	80074	CPT	3001124		Washington Regional Medical Center	outpatient	347	173.5	Self-Pay	Discounted Cash		34.35	260.25
HEPATITIS PANEL ACUTE	HEPATITIS PANEL ACUTE	Laboratory & Pathology	80074	CPT	3001124		Washington Regional Medical Center	outpatient	347	173.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	260.25	34.35	260.25
HEPATITIS PANEL ACUTE	HEPATITIS PANEL ACUTE	Laboratory & Pathology	80074	CPT	3001124		Washington Regional Medical Center	outpatient	347	173.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	152.68	34.35	260.25
HEPATITIS PANEL ACUTE	HEPATITIS PANEL ACUTE	Laboratory & Pathology	80074	CPT	3001124		Washington Regional Medical Center	outpatient	347	173.5	Humana	Medicare Advantage HMO/PPO/PFFS	163.09	34.35	260.25
HEPATITIS PANEL ACUTE	HEPATITIS PANEL ACUTE	Laboratory & Pathology	80074	CPT	3001124		Washington Regional Medical Center	outpatient	347	173.5	AmeriHealth Caritas North Carolina	NC Medicaid	85	34.35	260.25
HEPATITIS PANEL ACUTE	HEPATITIS PANEL ACUTE	Laboratory & Pathology	80074	CPT	3001124		Washington Regional Medical Center	outpatient	347	173.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	85	34.35	260.25
HEPATITIS PANEL ACUTE	HEPATITIS PANEL ACUTE	Laboratory & Pathology	80074	CPT	3001124		Washington Regional Medical Center	outpatient	347	173.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	85	34.35	260.25
HEPATITIS PANEL ACUTE	HEPATITIS PANEL ACUTE	Laboratory & Pathology	80074	CPT	3001124		Washington Regional Medical Center	outpatient	347	173.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	85	34.35	260.25
HEPATITIS PANEL ACUTE	HEPATITIS PANEL ACUTE	Laboratory & Pathology	80074	CPT	3001124		Washington Regional Medical Center	outpatient	347	173.5	Cigna	North Carolina PPO-PPA Direct	34.35	34.35	260.25
HEPATITIS PANEL ACUTE	HEPATITIS PANEL ACUTE	Laboratory & Pathology	80074	CPT	3001124		Washington Regional Medical Center	outpatient	347	173.5	Original Medicare	Traditional Medicare Fee-for-Service	163.09	34.35	260.25
INSULIN FREE	INSULIN FREE	Laboratory & Pathology	83527	CPT	3002261		Washington Regional Medical Center	outpatient	150	75	Self-Pay	Discounted Cash		8.41	112.5
INSULIN FREE	INSULIN FREE	Laboratory & Pathology	83527	CPT	3002261		Washington Regional Medical Center	outpatient	150	75	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	112.5	8.41	112.5
INSULIN FREE	INSULIN FREE	Laboratory & Pathology	83527	CPT	3002261		Washington Regional Medical Center	outpatient	150	75	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	66	8.41	112.5
INSULIN FREE	INSULIN FREE	Laboratory & Pathology	83527	CPT	3002261		Washington Regional Medical Center	outpatient	150	75	Humana	Medicare Advantage HMO/PPO/PFFS	70.5	8.41	112.5
INSULIN FREE	INSULIN FREE	Laboratory & Pathology	83527	CPT	3002261		Washington Regional Medical Center	outpatient	150	75	AmeriHealth Caritas North Carolina	NC Medicaid	23.08	8.41	112.5
INSULIN FREE	INSULIN FREE	Laboratory & Pathology	83527	CPT	3002261		Washington Regional Medical Center	outpatient	150	75	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	23.08	8.41	112.5
INSULIN FREE	INSULIN FREE	Laboratory & Pathology	83527	CPT	3002261		Washington Regional Medical Center	outpatient	150	75	WellCare of North Carolina	North Carolina Medicaid/CHIP	23.08	8.41	112.5
INSULIN FREE	INSULIN FREE	Laboratory & Pathology	83527	CPT	3002261		Washington Regional Medical Center	outpatient	150	75	Healthy Blue / Blue Cross NC	North Carolina Medicaid	23.08	8.41	112.5
INSULIN FREE	INSULIN FREE	Laboratory & Pathology	83527	CPT	3002261		Washington Regional Medical Center	outpatient	150	75	Cigna	North Carolina PPO-PPA Direct	8.41	8.41	112.5
INSULIN FREE	INSULIN FREE	Laboratory & Pathology	83527	CPT	3002261		Washington Regional Medical Center	outpatient	150	75	Original Medicare	Traditional Medicare Fee-for-Service	70.5	8.41	112.5
ISLET CELL ANTIBODY	ISLET CELL ANTIBODY	Laboratory & Pathology	86341	CPT	3001950		Washington Regional Medical Center	outpatient	175	87.5	Self-Pay	Discounted Cash		12.8	131.25
ISLET CELL ANTIBODY	ISLET CELL ANTIBODY	Laboratory & Pathology	86341	CPT	3001950		Washington Regional Medical Center	outpatient	175	87.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	131.25	12.8	131.25
ISLET CELL ANTIBODY	ISLET CELL ANTIBODY	Laboratory & Pathology	86341	CPT	3001950		Washington Regional Medical Center	outpatient	175	87.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	77	12.8	131.25
ISLET CELL ANTIBODY	ISLET CELL ANTIBODY	Laboratory & Pathology	86341	CPT	3001950		Washington Regional Medical Center	outpatient	175	87.5	Humana	Medicare Advantage HMO/PPO/PFFS	82.25	12.8	131.25
ISLET CELL ANTIBODY	ISLET CELL ANTIBODY	Laboratory & Pathology	86341	CPT	3001950		Washington Regional Medical Center	outpatient	175	87.5	AmeriHealth Caritas North Carolina	NC Medicaid	24.5	12.8	131.25
ISLET CELL ANTIBODY	ISLET CELL ANTIBODY	Laboratory & Pathology	86341	CPT	3001950		Washington Regional Medical Center	outpatient	175	87.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	24.5	12.8	131.25
ISLET CELL ANTIBODY	ISLET CELL ANTIBODY	Laboratory & Pathology	86341	CPT	3001950		Washington Regional Medical Center	outpatient	175	87.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	24.5	12.8	131.25
ISLET CELL ANTIBODY	ISLET CELL ANTIBODY	Laboratory & Pathology	86341	CPT	3001950		Washington Regional Medical Center	outpatient	175	87.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	24.5	12.8	131.25
ISLET CELL ANTIBODY	ISLET CELL ANTIBODY	Laboratory & Pathology	86341	CPT	3001950		Washington Regional Medical Center	outpatient	175	87.5	Cigna	North Carolina PPO-PPA Direct	12.8	12.8	131.25
ISLET CELL ANTIBODY	ISLET CELL ANTIBODY	Laboratory & Pathology	86341	CPT	3001950		Washington Regional Medical Center	outpatient	175	87.5	Original Medicare	Traditional Medicare Fee-for-Service	82.25	12.8	131.25
Kidney function panel test	RENAL PANEL	Laboratory & Pathology	80069	CPT	3001032		Washington Regional Medical Center	outpatient	140	70	Self-Pay	Discounted Cash		5.61	105
Kidney function panel test	RENAL PANEL	Laboratory & Pathology	80069	CPT	3001032		Washington Regional Medical Center	outpatient	140	70	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	105	5.61	105
Kidney function panel test	RENAL PANEL	Laboratory & Pathology	80069	CPT	3001032		Washington Regional Medical Center	outpatient	140	70	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	61.6	5.61	105
Kidney function panel test	RENAL PANEL	Laboratory & Pathology	80069	CPT	3001032		Washington Regional Medical Center	outpatient	140	70	Humana	Medicare Advantage HMO/PPO/PFFS	65.8	5.61	105
Kidney function panel test	RENAL PANEL	Laboratory & Pathology	80069	CPT	3001032		Washington Regional Medical Center	outpatient	140	70	AmeriHealth Caritas North Carolina	NC Medicaid	14.62	5.61	105
Kidney function panel test	RENAL PANEL	Laboratory & Pathology	80069	CPT	3001032		Washington Regional Medical Center	outpatient	140	70	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	14.62	5.61	105
Kidney function panel test	RENAL PANEL	Laboratory & Pathology	80069	CPT	3001032		Washington Regional Medical Center	outpatient	140	70	WellCare of North Carolina	North Carolina Medicaid/CHIP	14.62	5.61	105
Kidney function panel test	RENAL PANEL	Laboratory & Pathology	80069	CPT	3001032		Washington Regional Medical Center	outpatient	140	70	Healthy Blue / Blue Cross NC	North Carolina Medicaid	14.62	5.61	105
Kidney function panel test	RENAL PANEL	Laboratory & Pathology	80069	CPT	3001032		Washington Regional Medical Center	outpatient	140	70	Cigna	North Carolina PPO-PPA Direct	5.61	5.61	105
Kidney function panel test	RENAL PANEL	Laboratory & Pathology	80069	CPT	3001032		Washington Regional Medical Center	outpatient	140	70	Original Medicare	Traditional Medicare Fee-for-Service	65.8	5.61	105
LAMOTRIGINE (LAMICTAL)	LAMOTRIGINE (LAMICTAL)	Laboratory & Pathology	80175	CPT	3001772		Washington Regional Medical Center	outpatient	175	87.5	Self-Pay	Discounted Cash		8.76	131.25
LAMOTRIGINE (LAMICTAL)	LAMOTRIGINE (LAMICTAL)	Laboratory & Pathology	80175	CPT	3001772		Washington Regional Medical Center	outpatient	175	87.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	131.25	8.76	131.25
LAMOTRIGINE (LAMICTAL)	LAMOTRIGINE (LAMICTAL)	Laboratory & Pathology	80175	CPT	3001772		Washington Regional Medical Center	outpatient	175	87.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	77	8.76	131.25
LAMOTRIGINE (LAMICTAL)	LAMOTRIGINE (LAMICTAL)	Laboratory & Pathology	80175	CPT	3001772		Washington Regional Medical Center	outpatient	175	87.5	Humana	Medicare Advantage HMO/PPO/PFFS	82.25	8.76	131.25
LAMOTRIGINE (LAMICTAL)	LAMOTRIGINE (LAMICTAL)	Laboratory & Pathology	80175	CPT	3001772		Washington Regional Medical Center	outpatient	175	87.5	AmeriHealth Caritas North Carolina	NC Medicaid	23.61	8.76	131.25
LAMOTRIGINE (LAMICTAL)	LAMOTRIGINE (LAMICTAL)	Laboratory & Pathology	80175	CPT	3001772		Washington Regional Medical Center	outpatient	175	87.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	23.61	8.76	131.25
LAMOTRIGINE (LAMICTAL)	LAMOTRIGINE (LAMICTAL)	Laboratory & Pathology	80175	CPT	3001772		Washington Regional Medical Center	outpatient	175	87.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	23.61	8.76	131.25
LAMOTRIGINE (LAMICTAL)	LAMOTRIGINE (LAMICTAL)	Laboratory & Pathology	80175	CPT	3001772		Washington Regional Medical Center	outpatient	175	87.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	23.61	8.76	131.25
LAMOTRIGINE (LAMICTAL)	LAMOTRIGINE (LAMICTAL)	Laboratory & Pathology	80175	CPT	3001772		Washington Regional Medical Center	outpatient	175	87.5	Cigna	North Carolina PPO-PPA Direct	8.76	8.76	131.25
LAMOTRIGINE (LAMICTAL)	LAMOTRIGINE (LAMICTAL)	Laboratory & Pathology	80175	CPT	3001772		Washington Regional Medical Center	outpatient	175	87.5	Original Medicare	Traditional Medicare Fee-for-Service	82.25	8.76	131.25
LEVETIRACETAM (KEPPRA)	LEVETIRACETAM (KEPPRA)	Laboratory & Pathology	80177	CPT	3001893		Washington Regional Medical Center	outpatient	163	81.5	Self-Pay	Discounted Cash		8.76	122.25
LEVETIRACETAM (KEPPRA)	LEVETIRACETAM (KEPPRA)	Laboratory & Pathology	80177	CPT	3001893		Washington Regional Medical Center	outpatient	163	81.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	122.25	8.76	122.25
LEVETIRACETAM (KEPPRA)	LEVETIRACETAM (KEPPRA)	Laboratory & Pathology	80177	CPT	3001893		Washington Regional Medical Center	outpatient	163	81.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	71.72	8.76	122.25
LEVETIRACETAM (KEPPRA)	LEVETIRACETAM (KEPPRA)	Laboratory & Pathology	80177	CPT	3001893		Washington Regional Medical Center	outpatient	163	81.5	Humana	Medicare Advantage HMO/PPO/PFFS	76.61	8.76	122.25
LEVETIRACETAM (KEPPRA)	LEVETIRACETAM (KEPPRA)	Laboratory & Pathology	80177	CPT	3001893		Washington Regional Medical Center	outpatient	163	81.5	AmeriHealth Caritas North Carolina	NC Medicaid	23.61	8.76	122.25
LEVETIRACETAM (KEPPRA)	LEVETIRACETAM (KEPPRA)	Laboratory & Pathology	80177	CPT	3001893		Washington Regional Medical Center	outpatient	163	81.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	23.61	8.76	122.25
LEVETIRACETAM (KEPPRA)	LEVETIRACETAM (KEPPRA)	Laboratory & Pathology	80177	CPT	3001893		Washington Regional Medical Center	outpatient	163	81.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	23.61	8.76	122.25
LEVETIRACETAM (KEPPRA)	LEVETIRACETAM (KEPPRA)	Laboratory & Pathology	80177	CPT	3001893		Washington Regional Medical Center	outpatient	163	81.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	23.61	8.76	122.25
LEVETIRACETAM (KEPPRA)	LEVETIRACETAM (KEPPRA)	Laboratory & Pathology	80177	CPT	3001893		Washington Regional Medical Center	outpatient	163	81.5	Cigna	North Carolina PPO-PPA Direct	8.76	8.76	122.25
LEVETIRACETAM (KEPPRA)	LEVETIRACETAM (KEPPRA)	Laboratory & Pathology	80177	CPT	3001893		Washington Regional Medical Center	outpatient	163	81.5	Original Medicare	Traditional Medicare Fee-for-Service	76.61	8.76	122.25
LIPASE	LIPASE	Laboratory & Pathology	83690	CPT	3001085		Washington Regional Medical Center	outpatient	140	70	Self-Pay	Discounted Cash		4.38	105
LIPASE	LIPASE	Laboratory & Pathology	83690	CPT	3001085		Washington Regional Medical Center	outpatient	140	70	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	105	4.38	105
LIPASE	LIPASE	Laboratory & Pathology	83690	CPT	3001085		Washington Regional Medical Center	outpatient	140	70	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	61.6	4.38	105
LIPASE	LIPASE	Laboratory & Pathology	83690	CPT	3001085		Washington Regional Medical Center	outpatient	140	70	Humana	Medicare Advantage HMO/PPO/PFFS	65.8	4.38	105
LIPASE	LIPASE	Laboratory & Pathology	83690	CPT	3001085		Washington Regional Medical Center	outpatient	140	70	AmeriHealth Caritas North Carolina	NC Medicaid	12.56	4.38	105
LIPASE	LIPASE	Laboratory & Pathology	83690	CPT	3001085		Washington Regional Medical Center	outpatient	140	70	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	12.56	4.38	105
LIPASE	LIPASE	Laboratory & Pathology	83690	CPT	3001085		Washington Regional Medical Center	outpatient	140	70	WellCare of North Carolina	North Carolina Medicaid/CHIP	12.56	4.38	105
LIPASE	LIPASE	Laboratory & Pathology	83690	CPT	3001085		Washington Regional Medical Center	outpatient	140	70	Healthy Blue / Blue Cross NC	North Carolina Medicaid	12.56	4.38	105
LIPASE	LIPASE	Laboratory & Pathology	83690	CPT	3001085		Washington Regional Medical Center	outpatient	140	70	Cigna	North Carolina PPO-PPA Direct	4.38	4.38	105
LIPASE	LIPASE	Laboratory & Pathology	83690	CPT	3001085		Washington Regional Medical Center	outpatient	140	70	Original Medicare	Traditional Medicare Fee-for-Service	65.8	4.38	105
LITHIUM	LITHIUM	Laboratory & Pathology	80178	CPT	3001190		Washington Regional Medical Center	outpatient	95	47.5	Self-Pay	Discounted Cash		4.21	71.25
LITHIUM	LITHIUM	Laboratory & Pathology	80178	CPT	3001190		Washington Regional Medical Center	outpatient	95	47.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	71.25	4.21	71.25
LITHIUM	LITHIUM	Laboratory & Pathology	80178	CPT	3001190		Washington Regional Medical Center	outpatient	95	47.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	41.8	4.21	71.25
LITHIUM	LITHIUM	Laboratory & Pathology	80178	CPT	3001190		Washington Regional Medical Center	outpatient	95	47.5	Humana	Medicare Advantage HMO/PPO/PFFS	44.65	4.21	71.25
LITHIUM	LITHIUM	Laboratory & Pathology	80178	CPT	3001190		Washington Regional Medical Center	outpatient	95	47.5	AmeriHealth Caritas North Carolina	NC Medicaid	12.06	4.21	71.25
LITHIUM	LITHIUM	Laboratory & Pathology	80178	CPT	3001190		Washington Regional Medical Center	outpatient	95	47.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	12.06	4.21	71.25
LITHIUM	LITHIUM	Laboratory & Pathology	80178	CPT	3001190		Washington Regional Medical Center	outpatient	95	47.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	12.06	4.21	71.25
LITHIUM	LITHIUM	Laboratory & Pathology	80178	CPT	3001190		Washington Regional Medical Center	outpatient	95	47.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	12.06	4.21	71.25
LITHIUM	LITHIUM	Laboratory & Pathology	80178	CPT	3001190		Washington Regional Medical Center	outpatient	95	47.5	Cigna	North Carolina PPO-PPA Direct	4.21	4.21	71.25
LITHIUM	LITHIUM	Laboratory & Pathology	80178	CPT	3001190		Washington Regional Medical Center	outpatient	95	47.5	Original Medicare	Traditional Medicare Fee-for-Service	44.65	4.21	71.25
Liver function blood test panel	LIVER PANEL	Laboratory & Pathology	80076	CPT	3001071		Washington Regional Medical Center	outpatient	185	92.5	Self-Pay	Discounted Cash		5.26	138.75
Liver function blood test panel	LIVER PANEL	Laboratory & Pathology	80076	CPT	3001071		Washington Regional Medical Center	outpatient	185	92.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	138.75	5.26	138.75
Liver function blood test panel	LIVER PANEL	Laboratory & Pathology	80076	CPT	3001071		Washington Regional Medical Center	outpatient	185	92.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	81.4	5.26	138.75
Liver function blood test panel	LIVER PANEL	Laboratory & Pathology	80076	CPT	3001071		Washington Regional Medical Center	outpatient	185	92.5	Humana	Medicare Advantage HMO/PPO/PFFS	86.95	5.26	138.75
Liver function blood test panel	LIVER PANEL	Laboratory & Pathology	80076	CPT	3001071		Washington Regional Medical Center	outpatient	185	92.5	AmeriHealth Caritas North Carolina	NC Medicaid	14.62	5.26	138.75
Liver function blood test panel	LIVER PANEL	Laboratory & Pathology	80076	CPT	3001071		Washington Regional Medical Center	outpatient	185	92.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	14.62	5.26	138.75
Liver function blood test panel	LIVER PANEL	Laboratory & Pathology	80076	CPT	3001071		Washington Regional Medical Center	outpatient	185	92.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	14.62	5.26	138.75
Liver function blood test panel	LIVER PANEL	Laboratory & Pathology	80076	CPT	3001071		Washington Regional Medical Center	outpatient	185	92.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	14.62	5.26	138.75
Liver function blood test panel	LIVER PANEL	Laboratory & Pathology	80076	CPT	3001071		Washington Regional Medical Center	outpatient	185	92.5	Cigna	North Carolina PPO-PPA Direct	5.26	5.26	138.75
Liver function blood test panel	LIVER PANEL	Laboratory & Pathology	80076	CPT	3001071		Washington Regional Medical Center	outpatient	185	92.5	Original Medicare	Traditional Medicare Fee-for-Service	86.95	5.26	138.75
Manual urinalysis test with examination using microscope	URINALYSIS NON-AUTO W/MICRO	Laboratory & Pathology	81000	CPT	8001081		Washington Regional Medical Center	outpatient	38	19	Self-Pay	Discounted Cash		3.37	28.5
Manual urinalysis test with examination using microscope	URINALYSIS NON-AUTO W/MICRO	Laboratory & Pathology	81000	CPT	8001081		Washington Regional Medical Center	outpatient	38	19	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	28.5	3.37	28.5
Manual urinalysis test with examination using microscope	URINALYSIS NON-AUTO W/MICRO	Laboratory & Pathology	81000	CPT	8001081		Washington Regional Medical Center	outpatient	38	19	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	16.72	3.37	28.5
Manual urinalysis test with examination using microscope	URINALYSIS NON-AUTO W/MICRO	Laboratory & Pathology	81000	CPT	8001081		Washington Regional Medical Center	outpatient	38	19	Humana	Medicare Advantage HMO/PPO/PFFS	17.86	3.37	28.5
Manual urinalysis test with examination using microscope	URINALYSIS NON-AUTO W/MICRO	Laboratory & Pathology	81000	CPT	8001081		Washington Regional Medical Center	outpatient	38	19	AmeriHealth Caritas North Carolina	NC Medicaid	5.78	3.37	28.5
Manual urinalysis test with examination using microscope	URINALYSIS NON-AUTO W/MICRO	Laboratory & Pathology	81000	CPT	8001081		Washington Regional Medical Center	outpatient	38	19	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	5.78	3.37	28.5
Manual urinalysis test with examination using microscope	URINALYSIS NON-AUTO W/MICRO	Laboratory & Pathology	81000	CPT	8001081		Washington Regional Medical Center	outpatient	38	19	WellCare of North Carolina	North Carolina Medicaid/CHIP	5.78	3.37	28.5
Manual urinalysis test with examination using microscope	URINALYSIS NON-AUTO W/MICRO	Laboratory & Pathology	81000	CPT	8001081		Washington Regional Medical Center	outpatient	38	19	Healthy Blue / Blue Cross NC	North Carolina Medicaid	5.78	3.37	28.5
Manual urinalysis test with examination using microscope	URINALYSIS NON-AUTO W/MICRO	Laboratory & Pathology	81000	CPT	8001081		Washington Regional Medical Center	outpatient	38	19	Cigna	North Carolina PPO-PPA Direct	3.37	3.37	28.5
Manual urinalysis test with examination using microscope	URINALYSIS NON-AUTO W/MICRO	Laboratory & Pathology	81000	CPT	8001081		Washington Regional Medical Center	outpatient	38	19	Original Medicare	Traditional Medicare Fee-for-Service	17.86	3.37	28.5
Manual urinalysis test with examination using microscope	URINE VOLUME MEASURMENT	Laboratory & Pathology	81000	CPT	8001601		Washington Regional Medical Center	outpatient	21	10.5	Self-Pay	Discounted Cash		3.37	15.75
Manual urinalysis test with examination using microscope	URINE VOLUME MEASURMENT	Laboratory & Pathology	81000	CPT	8001601		Washington Regional Medical Center	outpatient	21	10.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	15.75	3.37	15.75
Manual urinalysis test with examination using microscope	URINE VOLUME MEASURMENT	Laboratory & Pathology	81000	CPT	8001601		Washington Regional Medical Center	outpatient	21	10.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	9.24	3.37	15.75
Manual urinalysis test with examination using microscope	URINE VOLUME MEASURMENT	Laboratory & Pathology	81000	CPT	8001601		Washington Regional Medical Center	outpatient	21	10.5	Humana	Medicare Advantage HMO/PPO/PFFS	9.87	3.37	15.75
Manual urinalysis test with examination using microscope	URINE VOLUME MEASURMENT	Laboratory & Pathology	81000	CPT	8001601		Washington Regional Medical Center	outpatient	21	10.5	AmeriHealth Caritas North Carolina	NC Medicaid	5.78	3.37	15.75
Manual urinalysis test with examination using microscope	URINE VOLUME MEASURMENT	Laboratory & Pathology	81000	CPT	8001601		Washington Regional Medical Center	outpatient	21	10.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	5.78	3.37	15.75
Manual urinalysis test with examination using microscope	URINE VOLUME MEASURMENT	Laboratory & Pathology	81000	CPT	8001601		Washington Regional Medical Center	outpatient	21	10.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	5.78	3.37	15.75
Manual urinalysis test with examination using microscope	URINE VOLUME MEASURMENT	Laboratory & Pathology	81000	CPT	8001601		Washington Regional Medical Center	outpatient	21	10.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	5.78	3.37	15.75
Manual urinalysis test with examination using microscope	URINE VOLUME MEASURMENT	Laboratory & Pathology	81000	CPT	8001601		Washington Regional Medical Center	outpatient	21	10.5	Cigna	North Carolina PPO-PPA Direct	3.37	3.37	15.75
Manual urinalysis test with examination using microscope	URINE VOLUME MEASURMENT	Laboratory & Pathology	81000	CPT	8001601		Washington Regional Medical Center	outpatient	21	10.5	Original Medicare	Traditional Medicare Fee-for-Service	9.87	3.37	15.75
Manual urinalysis test with examination using microscope	URINALYSIS (+)	Laboratory & Pathology	81001	CPT	3001046		Washington Regional Medical Center	outpatient	136	68	Self-Pay	Discounted Cash		3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS (+)	Laboratory & Pathology	81001	CPT	3001046		Washington Regional Medical Center	outpatient	136	68	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	102	3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS (+)	Laboratory & Pathology	81001	CPT	3001046		Washington Regional Medical Center	outpatient	136	68	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	59.84	3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS (+)	Laboratory & Pathology	81001	CPT	3001046		Washington Regional Medical Center	outpatient	136	68	Humana	Medicare Advantage HMO/PPO/PFFS	63.92	3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS (+)	Laboratory & Pathology	81001	CPT	3001046		Washington Regional Medical Center	outpatient	136	68	AmeriHealth Caritas North Carolina	NC Medicaid	5.78	3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS (+)	Laboratory & Pathology	81001	CPT	3001046		Washington Regional Medical Center	outpatient	136	68	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	5.78	3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS (+)	Laboratory & Pathology	81001	CPT	3001046		Washington Regional Medical Center	outpatient	136	68	WellCare of North Carolina	North Carolina Medicaid/CHIP	5.78	3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS (+)	Laboratory & Pathology	81001	CPT	3001046		Washington Regional Medical Center	outpatient	136	68	Healthy Blue / Blue Cross NC	North Carolina Medicaid	5.78	3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS (+)	Laboratory & Pathology	81001	CPT	3001046		Washington Regional Medical Center	outpatient	136	68	Cigna	North Carolina PPO-PPA Direct	3.37	3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS (+)	Laboratory & Pathology	81001	CPT	3001046		Washington Regional Medical Center	outpatient	136	68	Original Medicare	Traditional Medicare Fee-for-Service	63.92	3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS NON-AUTO W/MICRO	Laboratory & Pathology	81001	CPT	3001226		Washington Regional Medical Center	outpatient	136	68	Self-Pay	Discounted Cash		3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS NON-AUTO W/MICRO	Laboratory & Pathology	81001	CPT	3001226		Washington Regional Medical Center	outpatient	136	68	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	102	3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS NON-AUTO W/MICRO	Laboratory & Pathology	81001	CPT	3001226		Washington Regional Medical Center	outpatient	136	68	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	59.84	3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS NON-AUTO W/MICRO	Laboratory & Pathology	81001	CPT	3001226		Washington Regional Medical Center	outpatient	136	68	Humana	Medicare Advantage HMO/PPO/PFFS	63.92	3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS NON-AUTO W/MICRO	Laboratory & Pathology	81001	CPT	3001226		Washington Regional Medical Center	outpatient	136	68	AmeriHealth Caritas North Carolina	NC Medicaid	5.78	3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS NON-AUTO W/MICRO	Laboratory & Pathology	81001	CPT	3001226		Washington Regional Medical Center	outpatient	136	68	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	5.78	3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS NON-AUTO W/MICRO	Laboratory & Pathology	81001	CPT	3001226		Washington Regional Medical Center	outpatient	136	68	WellCare of North Carolina	North Carolina Medicaid/CHIP	5.78	3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS NON-AUTO W/MICRO	Laboratory & Pathology	81001	CPT	3001226		Washington Regional Medical Center	outpatient	136	68	Healthy Blue / Blue Cross NC	North Carolina Medicaid	5.78	3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS NON-AUTO W/MICRO	Laboratory & Pathology	81001	CPT	3001226		Washington Regional Medical Center	outpatient	136	68	Cigna	North Carolina PPO-PPA Direct	3.37	3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS NON-AUTO W/MICRO	Laboratory & Pathology	81001	CPT	3001226		Washington Regional Medical Center	outpatient	136	68	Original Medicare	Traditional Medicare Fee-for-Service	63.92	3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS AUTO W/MICRO	Laboratory & Pathology	81001	CPT	3001358		Washington Regional Medical Center	outpatient	136	68	Self-Pay	Discounted Cash		3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS AUTO W/MICRO	Laboratory & Pathology	81001	CPT	3001358		Washington Regional Medical Center	outpatient	136	68	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	102	3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS AUTO W/MICRO	Laboratory & Pathology	81001	CPT	3001358		Washington Regional Medical Center	outpatient	136	68	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	59.84	3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS AUTO W/MICRO	Laboratory & Pathology	81001	CPT	3001358		Washington Regional Medical Center	outpatient	136	68	Humana	Medicare Advantage HMO/PPO/PFFS	63.92	3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS AUTO W/MICRO	Laboratory & Pathology	81001	CPT	3001358		Washington Regional Medical Center	outpatient	136	68	AmeriHealth Caritas North Carolina	NC Medicaid	5.78	3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS AUTO W/MICRO	Laboratory & Pathology	81001	CPT	3001358		Washington Regional Medical Center	outpatient	136	68	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	5.78	3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS AUTO W/MICRO	Laboratory & Pathology	81001	CPT	3001358		Washington Regional Medical Center	outpatient	136	68	WellCare of North Carolina	North Carolina Medicaid/CHIP	5.78	3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS AUTO W/MICRO	Laboratory & Pathology	81001	CPT	3001358		Washington Regional Medical Center	outpatient	136	68	Healthy Blue / Blue Cross NC	North Carolina Medicaid	5.78	3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS AUTO W/MICRO	Laboratory & Pathology	81001	CPT	3001358		Washington Regional Medical Center	outpatient	136	68	Cigna	North Carolina PPO-PPA Direct	3.37	3.37	102
Manual urinalysis test with examination using microscope	URINALYSIS AUTO W/MICRO	Laboratory & Pathology	81001	CPT	3001358		Washington Regional Medical Center	outpatient	136	68	Original Medicare	Traditional Medicare Fee-for-Service	63.92	3.37	102
Manual urinalysis test with examination using microscope	ZZ URINE DIPSTICK ONLY RHC	Laboratory & Pathology	81001	CPT	3020007		Washington Regional Medical Center	outpatient	13.92	6.96	Self-Pay	Discounted Cash		3.37	10.44
Manual urinalysis test with examination using microscope	ZZ URINE DIPSTICK ONLY RHC	Laboratory & Pathology	81001	CPT	3020007		Washington Regional Medical Center	outpatient	13.92	6.96	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	10.44	3.37	10.44
Manual urinalysis test with examination using microscope	ZZ URINE DIPSTICK ONLY RHC	Laboratory & Pathology	81001	CPT	3020007		Washington Regional Medical Center	outpatient	13.92	6.96	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	6.12	3.37	10.44
Manual urinalysis test with examination using microscope	ZZ URINE DIPSTICK ONLY RHC	Laboratory & Pathology	81001	CPT	3020007		Washington Regional Medical Center	outpatient	13.92	6.96	Humana	Medicare Advantage HMO/PPO/PFFS	6.54	3.37	10.44
Manual urinalysis test with examination using microscope	ZZ URINE DIPSTICK ONLY RHC	Laboratory & Pathology	81001	CPT	3020007		Washington Regional Medical Center	outpatient	13.92	6.96	AmeriHealth Caritas North Carolina	NC Medicaid	5.78	3.37	10.44
Manual urinalysis test with examination using microscope	ZZ URINE DIPSTICK ONLY RHC	Laboratory & Pathology	81001	CPT	3020007		Washington Regional Medical Center	outpatient	13.92	6.96	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	5.78	3.37	10.44
Manual urinalysis test with examination using microscope	ZZ URINE DIPSTICK ONLY RHC	Laboratory & Pathology	81001	CPT	3020007		Washington Regional Medical Center	outpatient	13.92	6.96	WellCare of North Carolina	North Carolina Medicaid/CHIP	5.78	3.37	10.44
Manual urinalysis test with examination using microscope	ZZ URINE DIPSTICK ONLY RHC	Laboratory & Pathology	81001	CPT	3020007		Washington Regional Medical Center	outpatient	13.92	6.96	Healthy Blue / Blue Cross NC	North Carolina Medicaid	5.78	3.37	10.44
Manual urinalysis test with examination using microscope	ZZ URINE DIPSTICK ONLY RHC	Laboratory & Pathology	81001	CPT	3020007		Washington Regional Medical Center	outpatient	13.92	6.96	Cigna	North Carolina PPO-PPA Direct	3.37	3.37	10.44
Manual urinalysis test with examination using microscope	ZZ URINE DIPSTICK ONLY RHC	Laboratory & Pathology	81001	CPT	3020007		Washington Regional Medical Center	outpatient	13.92	6.96	Original Medicare	Traditional Medicare Fee-for-Service	6.54	3.37	10.44
MDMA	MDMA	Laboratory & Pathology	80359	CPT	3020027		Washington Regional Medical Center	outpatient	4	2	Self-Pay	Discounted Cash		1.41	3
MDMA	MDMA	Laboratory & Pathology	80359	CPT	3020027		Washington Regional Medical Center	outpatient	4	2	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	3	1.41	3
MDMA	MDMA	Laboratory & Pathology	80359	CPT	3020027		Washington Regional Medical Center	outpatient	4	2	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	1.76	1.41	3
MDMA	MDMA	Laboratory & Pathology	80359	CPT	3020027		Washington Regional Medical Center	outpatient	4	2	Humana	Medicare Advantage HMO/PPO/PFFS	1.88	1.41	3
MDMA	MDMA	Laboratory & Pathology	80359	CPT	3020027		Washington Regional Medical Center	outpatient	4	2	AmeriHealth Caritas North Carolina	NC Medicaid	1.41	1.41	3
MDMA	MDMA	Laboratory & Pathology	80359	CPT	3020027		Washington Regional Medical Center	outpatient	4	2	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	1.41	1.41	3
MDMA	MDMA	Laboratory & Pathology	80359	CPT	3020027		Washington Regional Medical Center	outpatient	4	2	WellCare of North Carolina	North Carolina Medicaid/CHIP	1.41	1.41	3
MDMA	MDMA	Laboratory & Pathology	80359	CPT	3020027		Washington Regional Medical Center	outpatient	4	2	Healthy Blue / Blue Cross NC	North Carolina Medicaid	1.41	1.41	3
MDMA	MDMA	Laboratory & Pathology	80359	CPT	3020027		Washington Regional Medical Center	outpatient	4	2	Original Medicare	Traditional Medicare Fee-for-Service	1.88	1.41	3
MERCURY BLOOD	MERCURY BLOOD	Laboratory & Pathology	83825	CPT	3001601		Washington Regional Medical Center	outpatient	100	50	Self-Pay	Discounted Cash		10.52	75
MERCURY BLOOD	MERCURY BLOOD	Laboratory & Pathology	83825	CPT	3001601		Washington Regional Medical Center	outpatient	100	50	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	75	10.52	75
MERCURY BLOOD	MERCURY BLOOD	Laboratory & Pathology	83825	CPT	3001601		Washington Regional Medical Center	outpatient	100	50	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	44	10.52	75
MERCURY BLOOD	MERCURY BLOOD	Laboratory & Pathology	83825	CPT	3001601		Washington Regional Medical Center	outpatient	100	50	Humana	Medicare Advantage HMO/PPO/PFFS	47	10.52	75
MERCURY BLOOD	MERCURY BLOOD	Laboratory & Pathology	83825	CPT	3001601		Washington Regional Medical Center	outpatient	100	50	AmeriHealth Caritas North Carolina	NC Medicaid	29.67	10.52	75
MERCURY BLOOD	MERCURY BLOOD	Laboratory & Pathology	83825	CPT	3001601		Washington Regional Medical Center	outpatient	100	50	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	29.67	10.52	75
MERCURY BLOOD	MERCURY BLOOD	Laboratory & Pathology	83825	CPT	3001601		Washington Regional Medical Center	outpatient	100	50	WellCare of North Carolina	North Carolina Medicaid/CHIP	29.67	10.52	75
MERCURY BLOOD	MERCURY BLOOD	Laboratory & Pathology	83825	CPT	3001601		Washington Regional Medical Center	outpatient	100	50	Healthy Blue / Blue Cross NC	North Carolina Medicaid	29.67	10.52	75
MERCURY BLOOD	MERCURY BLOOD	Laboratory & Pathology	83825	CPT	3001601		Washington Regional Medical Center	outpatient	100	50	Cigna	North Carolina PPO-PPA Direct	10.52	10.52	75
MERCURY BLOOD	MERCURY BLOOD	Laboratory & Pathology	83825	CPT	3001601		Washington Regional Medical Center	outpatient	100	50	Original Medicare	Traditional Medicare Fee-for-Service	47	10.52	75
METHYLMALONIC ACID	METHYLMALONIC ACID	Laboratory & Pathology	83921	CPT	3001602		Washington Regional Medical Center	outpatient	243	121.5	Self-Pay	Discounted Cash		10.69	182.25
METHYLMALONIC ACID	METHYLMALONIC ACID	Laboratory & Pathology	83921	CPT	3001602		Washington Regional Medical Center	outpatient	243	121.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	182.25	10.69	182.25
METHYLMALONIC ACID	METHYLMALONIC ACID	Laboratory & Pathology	83921	CPT	3001602		Washington Regional Medical Center	outpatient	243	121.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	106.92	10.69	182.25
METHYLMALONIC ACID	METHYLMALONIC ACID	Laboratory & Pathology	83921	CPT	3001602		Washington Regional Medical Center	outpatient	243	121.5	Humana	Medicare Advantage HMO/PPO/PFFS	114.21	10.69	182.25
METHYLMALONIC ACID	METHYLMALONIC ACID	Laboratory & Pathology	83921	CPT	3001602		Washington Regional Medical Center	outpatient	243	121.5	AmeriHealth Caritas North Carolina	NC Medicaid	30.02	10.69	182.25
METHYLMALONIC ACID	METHYLMALONIC ACID	Laboratory & Pathology	83921	CPT	3001602		Washington Regional Medical Center	outpatient	243	121.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	30.02	10.69	182.25
METHYLMALONIC ACID	METHYLMALONIC ACID	Laboratory & Pathology	83921	CPT	3001602		Washington Regional Medical Center	outpatient	243	121.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	30.02	10.69	182.25
METHYLMALONIC ACID	METHYLMALONIC ACID	Laboratory & Pathology	83921	CPT	3001602		Washington Regional Medical Center	outpatient	243	121.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	30.02	10.69	182.25
METHYLMALONIC ACID	METHYLMALONIC ACID	Laboratory & Pathology	83921	CPT	3001602		Washington Regional Medical Center	outpatient	243	121.5	Cigna	North Carolina PPO-PPA Direct	10.69	10.69	182.25
METHYLMALONIC ACID	METHYLMALONIC ACID	Laboratory & Pathology	83921	CPT	3001602		Washington Regional Medical Center	outpatient	243	121.5	Original Medicare	Traditional Medicare Fee-for-Service	114.21	10.69	182.25
MRSA SCREEN	MRSA SCREEN	Laboratory & Pathology	87081	CPT	3001416		Washington Regional Medical Center	outpatient	100	50	Self-Pay	Discounted Cash		4.21	75
MRSA SCREEN	MRSA SCREEN	Laboratory & Pathology	87081	CPT	3001416		Washington Regional Medical Center	outpatient	100	50	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	75	4.21	75
MRSA SCREEN	MRSA SCREEN	Laboratory & Pathology	87081	CPT	3001416		Washington Regional Medical Center	outpatient	100	50	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	44	4.21	75
MRSA SCREEN	MRSA SCREEN	Laboratory & Pathology	87081	CPT	3001416		Washington Regional Medical Center	outpatient	100	50	Humana	Medicare Advantage HMO/PPO/PFFS	47	4.21	75
MRSA SCREEN	MRSA SCREEN	Laboratory & Pathology	87081	CPT	3001416		Washington Regional Medical Center	outpatient	100	50	AmeriHealth Caritas North Carolina	NC Medicaid	10.51	4.21	75
MRSA SCREEN	MRSA SCREEN	Laboratory & Pathology	87081	CPT	3001416		Washington Regional Medical Center	outpatient	100	50	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	10.51	4.21	75
MRSA SCREEN	MRSA SCREEN	Laboratory & Pathology	87081	CPT	3001416		Washington Regional Medical Center	outpatient	100	50	WellCare of North Carolina	North Carolina Medicaid/CHIP	10.51	4.21	75
MRSA SCREEN	MRSA SCREEN	Laboratory & Pathology	87081	CPT	3001416		Washington Regional Medical Center	outpatient	100	50	Healthy Blue / Blue Cross NC	North Carolina Medicaid	10.51	4.21	75
MRSA SCREEN	MRSA SCREEN	Laboratory & Pathology	87081	CPT	3001416		Washington Regional Medical Center	outpatient	100	50	Cigna	North Carolina PPO-PPA Direct	4.21	4.21	75
MRSA SCREEN	MRSA SCREEN	Laboratory & Pathology	87081	CPT	3001416		Washington Regional Medical Center	outpatient	100	50	Original Medicare	Traditional Medicare Fee-for-Service	47	4.21	75
MYCOPLASMA ANTIBODY	MYCOPLASMA ANTIBODY	Laboratory & Pathology	86738	CPT	3001192		Washington Regional Medical Center	outpatient	125	62.5	Self-Pay	Discounted Cash		8.59	93.75
MYCOPLASMA ANTIBODY	MYCOPLASMA ANTIBODY	Laboratory & Pathology	86738	CPT	3001192		Washington Regional Medical Center	outpatient	125	62.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	93.75	8.59	93.75
MYCOPLASMA ANTIBODY	MYCOPLASMA ANTIBODY	Laboratory & Pathology	86738	CPT	3001192		Washington Regional Medical Center	outpatient	125	62.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	55	8.59	93.75
MYCOPLASMA ANTIBODY	MYCOPLASMA ANTIBODY	Laboratory & Pathology	86738	CPT	3001192		Washington Regional Medical Center	outpatient	125	62.5	Humana	Medicare Advantage HMO/PPO/PFFS	58.75	8.59	93.75
MYCOPLASMA ANTIBODY	MYCOPLASMA ANTIBODY	Laboratory & Pathology	86738	CPT	3001192		Washington Regional Medical Center	outpatient	125	62.5	AmeriHealth Caritas North Carolina	NC Medicaid	24.15	8.59	93.75
MYCOPLASMA ANTIBODY	MYCOPLASMA ANTIBODY	Laboratory & Pathology	86738	CPT	3001192		Washington Regional Medical Center	outpatient	125	62.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	24.15	8.59	93.75
MYCOPLASMA ANTIBODY	MYCOPLASMA ANTIBODY	Laboratory & Pathology	86738	CPT	3001192		Washington Regional Medical Center	outpatient	125	62.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	24.15	8.59	93.75
MYCOPLASMA ANTIBODY	MYCOPLASMA ANTIBODY	Laboratory & Pathology	86738	CPT	3001192		Washington Regional Medical Center	outpatient	125	62.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	24.15	8.59	93.75
MYCOPLASMA ANTIBODY	MYCOPLASMA ANTIBODY	Laboratory & Pathology	86738	CPT	3001192		Washington Regional Medical Center	outpatient	125	62.5	Cigna	North Carolina PPO-PPA Direct	8.59	8.59	93.75
MYCOPLASMA ANTIBODY	MYCOPLASMA ANTIBODY	Laboratory & Pathology	86738	CPT	3001192		Washington Regional Medical Center	outpatient	125	62.5	Original Medicare	Traditional Medicare Fee-for-Service	58.75	8.59	93.75
Obstetric blood test panel	Obstetric blood test panel	Laboratory & Pathology	80055	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
OXCARBAZEPINE LEVEL	OXCARBAZEPINE LEVEL	Laboratory & Pathology	80183	CPT	3002413		Washington Regional Medical Center	outpatient	53	26.5	Self-Pay	Discounted Cash		8.76	39.75
OXCARBAZEPINE LEVEL	OXCARBAZEPINE LEVEL	Laboratory & Pathology	80183	CPT	3002413		Washington Regional Medical Center	outpatient	53	26.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	39.75	8.76	39.75
OXCARBAZEPINE LEVEL	OXCARBAZEPINE LEVEL	Laboratory & Pathology	80183	CPT	3002413		Washington Regional Medical Center	outpatient	53	26.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	23.32	8.76	39.75
OXCARBAZEPINE LEVEL	OXCARBAZEPINE LEVEL	Laboratory & Pathology	80183	CPT	3002413		Washington Regional Medical Center	outpatient	53	26.5	Humana	Medicare Advantage HMO/PPO/PFFS	24.91	8.76	39.75
OXCARBAZEPINE LEVEL	OXCARBAZEPINE LEVEL	Laboratory & Pathology	80183	CPT	3002413		Washington Regional Medical Center	outpatient	53	26.5	AmeriHealth Caritas North Carolina	NC Medicaid	23.61	8.76	39.75
OXCARBAZEPINE LEVEL	OXCARBAZEPINE LEVEL	Laboratory & Pathology	80183	CPT	3002413		Washington Regional Medical Center	outpatient	53	26.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	23.61	8.76	39.75
OXCARBAZEPINE LEVEL	OXCARBAZEPINE LEVEL	Laboratory & Pathology	80183	CPT	3002413		Washington Regional Medical Center	outpatient	53	26.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	23.61	8.76	39.75
OXCARBAZEPINE LEVEL	OXCARBAZEPINE LEVEL	Laboratory & Pathology	80183	CPT	3002413		Washington Regional Medical Center	outpatient	53	26.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	23.61	8.76	39.75
OXCARBAZEPINE LEVEL	OXCARBAZEPINE LEVEL	Laboratory & Pathology	80183	CPT	3002413		Washington Regional Medical Center	outpatient	53	26.5	Cigna	North Carolina PPO-PPA Direct	8.76	8.76	39.75
OXCARBAZEPINE LEVEL	OXCARBAZEPINE LEVEL	Laboratory & Pathology	80183	CPT	3002413		Washington Regional Medical Center	outpatient	53	26.5	Original Medicare	Traditional Medicare Fee-for-Service	24.91	8.76	39.75
OXYCODONE	OXYCODONE	Laboratory & Pathology	80365	CPT	3001443		Washington Regional Medical Center	outpatient	53	26.5	Self-Pay	Discounted Cash		18.63	39.75
OXYCODONE	OXYCODONE	Laboratory & Pathology	80365	CPT	3001443		Washington Regional Medical Center	outpatient	53	26.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	39.75	18.63	39.75
OXYCODONE	OXYCODONE	Laboratory & Pathology	80365	CPT	3001443		Washington Regional Medical Center	outpatient	53	26.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	23.32	18.63	39.75
OXYCODONE	OXYCODONE	Laboratory & Pathology	80365	CPT	3001443		Washington Regional Medical Center	outpatient	53	26.5	Humana	Medicare Advantage HMO/PPO/PFFS	24.91	18.63	39.75
OXYCODONE	OXYCODONE	Laboratory & Pathology	80365	CPT	3001443		Washington Regional Medical Center	outpatient	53	26.5	AmeriHealth Caritas North Carolina	NC Medicaid	18.63	18.63	39.75
OXYCODONE	OXYCODONE	Laboratory & Pathology	80365	CPT	3001443		Washington Regional Medical Center	outpatient	53	26.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	18.63	18.63	39.75
OXYCODONE	OXYCODONE	Laboratory & Pathology	80365	CPT	3001443		Washington Regional Medical Center	outpatient	53	26.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	18.63	18.63	39.75
OXYCODONE	OXYCODONE	Laboratory & Pathology	80365	CPT	3001443		Washington Regional Medical Center	outpatient	53	26.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	18.63	18.63	39.75
OXYCODONE	OXYCODONE	Laboratory & Pathology	80365	CPT	3001443		Washington Regional Medical Center	outpatient	53	26.5	Original Medicare	Traditional Medicare Fee-for-Service	24.91	18.63	39.75
PHENOBARBITAL	PHENOBARBITAL	Laboratory & Pathology	80184	CPT	3001024		Washington Regional Medical Center	outpatient	112	56	Self-Pay	Discounted Cash		7.36	84
PHENOBARBITAL	PHENOBARBITAL	Laboratory & Pathology	80184	CPT	3001024		Washington Regional Medical Center	outpatient	112	56	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	84	7.36	84
PHENOBARBITAL	PHENOBARBITAL	Laboratory & Pathology	80184	CPT	3001024		Washington Regional Medical Center	outpatient	112	56	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	49.28	7.36	84
PHENOBARBITAL	PHENOBARBITAL	Laboratory & Pathology	80184	CPT	3001024		Washington Regional Medical Center	outpatient	112	56	Humana	Medicare Advantage HMO/PPO/PFFS	52.64	7.36	84
PHENOBARBITAL	PHENOBARBITAL	Laboratory & Pathology	80184	CPT	3001024		Washington Regional Medical Center	outpatient	112	56	AmeriHealth Caritas North Carolina	NC Medicaid	20.9	7.36	84
PHENOBARBITAL	PHENOBARBITAL	Laboratory & Pathology	80184	CPT	3001024		Washington Regional Medical Center	outpatient	112	56	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	20.9	7.36	84
PHENOBARBITAL	PHENOBARBITAL	Laboratory & Pathology	80184	CPT	3001024		Washington Regional Medical Center	outpatient	112	56	WellCare of North Carolina	North Carolina Medicaid/CHIP	20.9	7.36	84
PHENOBARBITAL	PHENOBARBITAL	Laboratory & Pathology	80184	CPT	3001024		Washington Regional Medical Center	outpatient	112	56	Healthy Blue / Blue Cross NC	North Carolina Medicaid	20.9	7.36	84
PHENOBARBITAL	PHENOBARBITAL	Laboratory & Pathology	80184	CPT	3001024		Washington Regional Medical Center	outpatient	112	56	Cigna	North Carolina PPO-PPA Direct	7.36	7.36	84
PHENOBARBITAL	PHENOBARBITAL	Laboratory & Pathology	80184	CPT	3001024		Washington Regional Medical Center	outpatient	112	56	Original Medicare	Traditional Medicare Fee-for-Service	52.64	7.36	84
PHENYTOIN;FREE	PHENYTOIN;FREE	Laboratory & Pathology	80186	CPT	3002565		Washington Regional Medical Center	outpatient	162	81	Self-Pay	Discounted Cash		8.94	121.5
PHENYTOIN;FREE	PHENYTOIN;FREE	Laboratory & Pathology	80186	CPT	3002565		Washington Regional Medical Center	outpatient	162	81	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	121.5	8.94	121.5
PHENYTOIN;FREE	PHENYTOIN;FREE	Laboratory & Pathology	80186	CPT	3002565		Washington Regional Medical Center	outpatient	162	81	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	71.28	8.94	121.5
PHENYTOIN;FREE	PHENYTOIN;FREE	Laboratory & Pathology	80186	CPT	3002565		Washington Regional Medical Center	outpatient	162	81	Humana	Medicare Advantage HMO/PPO/PFFS	76.14	8.94	121.5
PHENYTOIN;FREE	PHENYTOIN;FREE	Laboratory & Pathology	80186	CPT	3002565		Washington Regional Medical Center	outpatient	162	81	AmeriHealth Caritas North Carolina	NC Medicaid	25.1	8.94	121.5
PHENYTOIN;FREE	PHENYTOIN;FREE	Laboratory & Pathology	80186	CPT	3002565		Washington Regional Medical Center	outpatient	162	81	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	25.1	8.94	121.5
PHENYTOIN;FREE	PHENYTOIN;FREE	Laboratory & Pathology	80186	CPT	3002565		Washington Regional Medical Center	outpatient	162	81	WellCare of North Carolina	North Carolina Medicaid/CHIP	25.1	8.94	121.5
PHENYTOIN;FREE	PHENYTOIN;FREE	Laboratory & Pathology	80186	CPT	3002565		Washington Regional Medical Center	outpatient	162	81	Healthy Blue / Blue Cross NC	North Carolina Medicaid	25.1	8.94	121.5
PHENYTOIN;FREE	PHENYTOIN;FREE	Laboratory & Pathology	80186	CPT	3002565		Washington Regional Medical Center	outpatient	162	81	Cigna	North Carolina PPO-PPA Direct	8.94	8.94	121.5
PHENYTOIN;FREE	PHENYTOIN;FREE	Laboratory & Pathology	80186	CPT	3002565		Washington Regional Medical Center	outpatient	162	81	Original Medicare	Traditional Medicare Fee-for-Service	76.14	8.94	121.5
PKU STATE	PKU STATE	Laboratory & Pathology	84030	CPT	3001428		Washington Regional Medical Center	outpatient	205	102.5	Self-Pay	Discounted Cash		5.61	153.75
PKU STATE	PKU STATE	Laboratory & Pathology	84030	CPT	3001428		Washington Regional Medical Center	outpatient	205	102.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	153.75	5.61	153.75
PKU STATE	PKU STATE	Laboratory & Pathology	84030	CPT	3001428		Washington Regional Medical Center	outpatient	205	102.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	90.2	5.61	153.75
PKU STATE	PKU STATE	Laboratory & Pathology	84030	CPT	3001428		Washington Regional Medical Center	outpatient	205	102.5	Humana	Medicare Advantage HMO/PPO/PFFS	96.35	5.61	153.75
PKU STATE	PKU STATE	Laboratory & Pathology	84030	CPT	3001428		Washington Regional Medical Center	outpatient	205	102.5	AmeriHealth Caritas North Carolina	NC Medicaid	10.04	5.61	153.75
PKU STATE	PKU STATE	Laboratory & Pathology	84030	CPT	3001428		Washington Regional Medical Center	outpatient	205	102.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	10.04	5.61	153.75
PKU STATE	PKU STATE	Laboratory & Pathology	84030	CPT	3001428		Washington Regional Medical Center	outpatient	205	102.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	10.04	5.61	153.75
PKU STATE	PKU STATE	Laboratory & Pathology	84030	CPT	3001428		Washington Regional Medical Center	outpatient	205	102.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	10.04	5.61	153.75
PKU STATE	PKU STATE	Laboratory & Pathology	84030	CPT	3001428		Washington Regional Medical Center	outpatient	205	102.5	Cigna	North Carolina PPO-PPA Direct	5.61	5.61	153.75
PKU STATE	PKU STATE	Laboratory & Pathology	84030	CPT	3001428		Washington Regional Medical Center	outpatient	205	102.5	Original Medicare	Traditional Medicare Fee-for-Service	96.35	5.61	153.75
POTASSIUM URINE	POTASSIUM URINE	Laboratory & Pathology	84133	CPT	3001514		Washington Regional Medical Center	outpatient	48	24	Self-Pay	Discounted Cash		2.8	36
POTASSIUM URINE	POTASSIUM URINE	Laboratory & Pathology	84133	CPT	3001514		Washington Regional Medical Center	outpatient	48	24	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	36	2.8	36
POTASSIUM URINE	POTASSIUM URINE	Laboratory & Pathology	84133	CPT	3001514		Washington Regional Medical Center	outpatient	48	24	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	21.12	2.8	36
POTASSIUM URINE	POTASSIUM URINE	Laboratory & Pathology	84133	CPT	3001514		Washington Regional Medical Center	outpatient	48	24	Humana	Medicare Advantage HMO/PPO/PFFS	22.56	2.8	36
POTASSIUM URINE	POTASSIUM URINE	Laboratory & Pathology	84133	CPT	3001514		Washington Regional Medical Center	outpatient	48	24	AmeriHealth Caritas North Carolina	NC Medicaid	7.85	2.8	36
POTASSIUM URINE	POTASSIUM URINE	Laboratory & Pathology	84133	CPT	3001514		Washington Regional Medical Center	outpatient	48	24	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	7.85	2.8	36
POTASSIUM URINE	POTASSIUM URINE	Laboratory & Pathology	84133	CPT	3001514		Washington Regional Medical Center	outpatient	48	24	WellCare of North Carolina	North Carolina Medicaid/CHIP	7.85	2.8	36
POTASSIUM URINE	POTASSIUM URINE	Laboratory & Pathology	84133	CPT	3001514		Washington Regional Medical Center	outpatient	48	24	Healthy Blue / Blue Cross NC	North Carolina Medicaid	7.85	2.8	36
POTASSIUM URINE	POTASSIUM URINE	Laboratory & Pathology	84133	CPT	3001514		Washington Regional Medical Center	outpatient	48	24	Cigna	North Carolina PPO-PPA Direct	2.8	2.8	36
POTASSIUM URINE	POTASSIUM URINE	Laboratory & Pathology	84133	CPT	3001514		Washington Regional Medical Center	outpatient	48	24	Original Medicare	Traditional Medicare Fee-for-Service	22.56	2.8	36
PROLACTIN	PROLACTIN	Laboratory & Pathology	84146	CPT	3001434		Washington Regional Medical Center	outpatient	220	110	Self-Pay	Discounted Cash		12.44	165
PROLACTIN	PROLACTIN	Laboratory & Pathology	84146	CPT	3001434		Washington Regional Medical Center	outpatient	220	110	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	165	12.44	165
PROLACTIN	PROLACTIN	Laboratory & Pathology	84146	CPT	3001434		Washington Regional Medical Center	outpatient	220	110	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	96.8	12.44	165
PROLACTIN	PROLACTIN	Laboratory & Pathology	84146	CPT	3001434		Washington Regional Medical Center	outpatient	220	110	Humana	Medicare Advantage HMO/PPO/PFFS	103.4	12.44	165
PROLACTIN	PROLACTIN	Laboratory & Pathology	84146	CPT	3001434		Washington Regional Medical Center	outpatient	220	110	AmeriHealth Caritas North Carolina	NC Medicaid	35.35	12.44	165
PROLACTIN	PROLACTIN	Laboratory & Pathology	84146	CPT	3001434		Washington Regional Medical Center	outpatient	220	110	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	35.35	12.44	165
PROLACTIN	PROLACTIN	Laboratory & Pathology	84146	CPT	3001434		Washington Regional Medical Center	outpatient	220	110	WellCare of North Carolina	North Carolina Medicaid/CHIP	35.35	12.44	165
PROLACTIN	PROLACTIN	Laboratory & Pathology	84146	CPT	3001434		Washington Regional Medical Center	outpatient	220	110	Healthy Blue / Blue Cross NC	North Carolina Medicaid	35.35	12.44	165
PROLACTIN	PROLACTIN	Laboratory & Pathology	84146	CPT	3001434		Washington Regional Medical Center	outpatient	220	110	Cigna	North Carolina PPO-PPA Direct	12.44	12.44	165
PROLACTIN	PROLACTIN	Laboratory & Pathology	84146	CPT	3001434		Washington Regional Medical Center	outpatient	220	110	Original Medicare	Traditional Medicare Fee-for-Service	103.4	12.44	165
PROTEIN WESTERN BLOT	PROTEIN WESTERN BLOT	Laboratory & Pathology	84181	CPT	3002096		Washington Regional Medical Center	outpatient	104	52	Self-Pay	Discounted Cash		11.04	78
PROTEIN WESTERN BLOT	PROTEIN WESTERN BLOT	Laboratory & Pathology	84181	CPT	3002096		Washington Regional Medical Center	outpatient	104	52	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	78	11.04	78
PROTEIN WESTERN BLOT	PROTEIN WESTERN BLOT	Laboratory & Pathology	84181	CPT	3002096		Washington Regional Medical Center	outpatient	104	52	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	45.76	11.04	78
PROTEIN WESTERN BLOT	PROTEIN WESTERN BLOT	Laboratory & Pathology	84181	CPT	3002096		Washington Regional Medical Center	outpatient	104	52	Humana	Medicare Advantage HMO/PPO/PFFS	48.88	11.04	78
PROTEIN WESTERN BLOT	PROTEIN WESTERN BLOT	Laboratory & Pathology	84181	CPT	3002096		Washington Regional Medical Center	outpatient	104	52	AmeriHealth Caritas North Carolina	NC Medicaid	21.44	11.04	78
PROTEIN WESTERN BLOT	PROTEIN WESTERN BLOT	Laboratory & Pathology	84181	CPT	3002096		Washington Regional Medical Center	outpatient	104	52	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	21.44	11.04	78
PROTEIN WESTERN BLOT	PROTEIN WESTERN BLOT	Laboratory & Pathology	84181	CPT	3002096		Washington Regional Medical Center	outpatient	104	52	WellCare of North Carolina	North Carolina Medicaid/CHIP	21.44	11.04	78
PROTEIN WESTERN BLOT	PROTEIN WESTERN BLOT	Laboratory & Pathology	84181	CPT	3002096		Washington Regional Medical Center	outpatient	104	52	Healthy Blue / Blue Cross NC	North Carolina Medicaid	21.44	11.04	78
PROTEIN WESTERN BLOT	PROTEIN WESTERN BLOT	Laboratory & Pathology	84181	CPT	3002096		Washington Regional Medical Center	outpatient	104	52	Cigna	North Carolina PPO-PPA Direct	11.04	11.04	78
PROTEIN WESTERN BLOT	PROTEIN WESTERN BLOT	Laboratory & Pathology	84181	CPT	3002096		Washington Regional Medical Center	outpatient	104	52	Original Medicare	Traditional Medicare Fee-for-Service	48.88	11.04	78
PSA (prostate specific antigen)	PSA (SCREENING)	Laboratory & Pathology	84153	CPT	3001101		Washington Regional Medical Center	outpatient	138	69	Self-Pay	Discounted Cash		11.92	103.5
PSA (prostate specific antigen)	PSA (SCREENING)	Laboratory & Pathology	84153	CPT	3001101		Washington Regional Medical Center	outpatient	138	69	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	103.5	11.92	103.5
PSA (prostate specific antigen)	PSA (SCREENING)	Laboratory & Pathology	84153	CPT	3001101		Washington Regional Medical Center	outpatient	138	69	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	60.72	11.92	103.5
PSA (prostate specific antigen)	PSA (SCREENING)	Laboratory & Pathology	84153	CPT	3001101		Washington Regional Medical Center	outpatient	138	69	Humana	Medicare Advantage HMO/PPO/PFFS	64.86	11.92	103.5
PSA (prostate specific antigen)	PSA (SCREENING)	Laboratory & Pathology	84153	CPT	3001101		Washington Regional Medical Center	outpatient	138	69	AmeriHealth Caritas North Carolina	NC Medicaid	33.55	11.92	103.5
PSA (prostate specific antigen)	PSA (SCREENING)	Laboratory & Pathology	84153	CPT	3001101		Washington Regional Medical Center	outpatient	138	69	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	33.55	11.92	103.5
PSA (prostate specific antigen)	PSA (SCREENING)	Laboratory & Pathology	84153	CPT	3001101		Washington Regional Medical Center	outpatient	138	69	WellCare of North Carolina	North Carolina Medicaid/CHIP	33.55	11.92	103.5
PSA (prostate specific antigen)	PSA (SCREENING)	Laboratory & Pathology	84153	CPT	3001101		Washington Regional Medical Center	outpatient	138	69	Healthy Blue / Blue Cross NC	North Carolina Medicaid	33.55	11.92	103.5
PSA (prostate specific antigen)	PSA (SCREENING)	Laboratory & Pathology	84153	CPT	3001101		Washington Regional Medical Center	outpatient	138	69	Cigna	North Carolina PPO-PPA Direct	11.92	11.92	103.5
PSA (prostate specific antigen)	PSA (SCREENING)	Laboratory & Pathology	84153	CPT	3001101		Washington Regional Medical Center	outpatient	138	69	Original Medicare	Traditional Medicare Fee-for-Service	64.86	11.92	103.5
PSA (prostate specific antigen)	PSA, TOTAL	Laboratory & Pathology	84153	CPT	3001561		Washington Regional Medical Center	outpatient	138	69	Self-Pay	Discounted Cash		11.92	103.5
PSA (prostate specific antigen)	PSA, TOTAL	Laboratory & Pathology	84153	CPT	3001561		Washington Regional Medical Center	outpatient	138	69	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	103.5	11.92	103.5
PSA (prostate specific antigen)	PSA, TOTAL	Laboratory & Pathology	84153	CPT	3001561		Washington Regional Medical Center	outpatient	138	69	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	60.72	11.92	103.5
PSA (prostate specific antigen)	PSA, TOTAL	Laboratory & Pathology	84153	CPT	3001561		Washington Regional Medical Center	outpatient	138	69	Humana	Medicare Advantage HMO/PPO/PFFS	64.86	11.92	103.5
PSA (prostate specific antigen)	PSA, TOTAL	Laboratory & Pathology	84153	CPT	3001561		Washington Regional Medical Center	outpatient	138	69	AmeriHealth Caritas North Carolina	NC Medicaid	33.55	11.92	103.5
PSA (prostate specific antigen)	PSA, TOTAL	Laboratory & Pathology	84153	CPT	3001561		Washington Regional Medical Center	outpatient	138	69	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	33.55	11.92	103.5
PSA (prostate specific antigen)	PSA, TOTAL	Laboratory & Pathology	84153	CPT	3001561		Washington Regional Medical Center	outpatient	138	69	WellCare of North Carolina	North Carolina Medicaid/CHIP	33.55	11.92	103.5
PSA (prostate specific antigen)	PSA, TOTAL	Laboratory & Pathology	84153	CPT	3001561		Washington Regional Medical Center	outpatient	138	69	Healthy Blue / Blue Cross NC	North Carolina Medicaid	33.55	11.92	103.5
PSA (prostate specific antigen)	PSA, TOTAL	Laboratory & Pathology	84153	CPT	3001561		Washington Regional Medical Center	outpatient	138	69	Cigna	North Carolina PPO-PPA Direct	11.92	11.92	103.5
PSA (prostate specific antigen)	PSA, TOTAL	Laboratory & Pathology	84153	CPT	3001561		Washington Regional Medical Center	outpatient	138	69	Original Medicare	Traditional Medicare Fee-for-Service	64.86	11.92	103.5
PSA (prostate specific antigen)	PSA FREE	Laboratory & Pathology	84154	CPT	3001448		Washington Regional Medical Center	outpatient	83	41.5	Self-Pay	Discounted Cash		11.92	62.25
PSA (prostate specific antigen)	PSA FREE	Laboratory & Pathology	84154	CPT	3001448		Washington Regional Medical Center	outpatient	83	41.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	62.25	11.92	62.25
PSA (prostate specific antigen)	PSA FREE	Laboratory & Pathology	84154	CPT	3001448		Washington Regional Medical Center	outpatient	83	41.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	36.52	11.92	62.25
PSA (prostate specific antigen)	PSA FREE	Laboratory & Pathology	84154	CPT	3001448		Washington Regional Medical Center	outpatient	83	41.5	Humana	Medicare Advantage HMO/PPO/PFFS	39.01	11.92	62.25
PSA (prostate specific antigen)	PSA FREE	Laboratory & Pathology	84154	CPT	3001448		Washington Regional Medical Center	outpatient	83	41.5	AmeriHealth Caritas North Carolina	NC Medicaid	33.55	11.92	62.25
PSA (prostate specific antigen)	PSA FREE	Laboratory & Pathology	84154	CPT	3001448		Washington Regional Medical Center	outpatient	83	41.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	33.55	11.92	62.25
PSA (prostate specific antigen)	PSA FREE	Laboratory & Pathology	84154	CPT	3001448		Washington Regional Medical Center	outpatient	83	41.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	33.55	11.92	62.25
PSA (prostate specific antigen)	PSA FREE	Laboratory & Pathology	84154	CPT	3001448		Washington Regional Medical Center	outpatient	83	41.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	33.55	11.92	62.25
PSA (prostate specific antigen)	PSA FREE	Laboratory & Pathology	84154	CPT	3001448		Washington Regional Medical Center	outpatient	83	41.5	Cigna	North Carolina PPO-PPA Direct	11.92	11.92	62.25
PSA (prostate specific antigen)	PSA FREE	Laboratory & Pathology	84154	CPT	3001448		Washington Regional Medical Center	outpatient	83	41.5	Original Medicare	Traditional Medicare Fee-for-Service	39.01	11.92	62.25
RA SCREEN	RA SCREEN	Laboratory & Pathology	86430	CPT	3001033		Washington Regional Medical Center	outpatient	143	71.5	Self-Pay	Discounted Cash		3.68	107.25
RA SCREEN	RA SCREEN	Laboratory & Pathology	86430	CPT	3001033		Washington Regional Medical Center	outpatient	143	71.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	107.25	3.68	107.25
RA SCREEN	RA SCREEN	Laboratory & Pathology	86430	CPT	3001033		Washington Regional Medical Center	outpatient	143	71.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	62.92	3.68	107.25
RA SCREEN	RA SCREEN	Laboratory & Pathology	86430	CPT	3001033		Washington Regional Medical Center	outpatient	143	71.5	Humana	Medicare Advantage HMO/PPO/PFFS	67.21	3.68	107.25
RA SCREEN	RA SCREEN	Laboratory & Pathology	86430	CPT	3001033		Washington Regional Medical Center	outpatient	143	71.5	AmeriHealth Caritas North Carolina	NC Medicaid	10.36	3.68	107.25
RA SCREEN	RA SCREEN	Laboratory & Pathology	86430	CPT	3001033		Washington Regional Medical Center	outpatient	143	71.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	10.36	3.68	107.25
RA SCREEN	RA SCREEN	Laboratory & Pathology	86430	CPT	3001033		Washington Regional Medical Center	outpatient	143	71.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	10.36	3.68	107.25
RA SCREEN	RA SCREEN	Laboratory & Pathology	86430	CPT	3001033		Washington Regional Medical Center	outpatient	143	71.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	10.36	3.68	107.25
RA SCREEN	RA SCREEN	Laboratory & Pathology	86430	CPT	3001033		Washington Regional Medical Center	outpatient	143	71.5	Cigna	North Carolina PPO-PPA Direct	3.68	3.68	107.25
RA SCREEN	RA SCREEN	Laboratory & Pathology	86430	CPT	3001033		Washington Regional Medical Center	outpatient	143	71.5	Original Medicare	Traditional Medicare Fee-for-Service	67.21	3.68	107.25
RBC	RBC	Laboratory & Pathology	85041	CPT	3001036		Washington Regional Medical Center	outpatient	38	19	Self-Pay	Discounted Cash		1.93	28.5
RBC	RBC	Laboratory & Pathology	85041	CPT	3001036		Washington Regional Medical Center	outpatient	38	19	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	28.5	1.93	28.5
RBC	RBC	Laboratory & Pathology	85041	CPT	3001036		Washington Regional Medical Center	outpatient	38	19	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	16.72	1.93	28.5
RBC	RBC	Laboratory & Pathology	85041	CPT	3001036		Washington Regional Medical Center	outpatient	38	19	Humana	Medicare Advantage HMO/PPO/PFFS	17.86	1.93	28.5
RBC	RBC	Laboratory & Pathology	85041	CPT	3001036		Washington Regional Medical Center	outpatient	38	19	AmeriHealth Caritas North Carolina	NC Medicaid	5.47	1.93	28.5
RBC	RBC	Laboratory & Pathology	85041	CPT	3001036		Washington Regional Medical Center	outpatient	38	19	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	5.47	1.93	28.5
RBC	RBC	Laboratory & Pathology	85041	CPT	3001036		Washington Regional Medical Center	outpatient	38	19	WellCare of North Carolina	North Carolina Medicaid/CHIP	5.47	1.93	28.5
RBC	RBC	Laboratory & Pathology	85041	CPT	3001036		Washington Regional Medical Center	outpatient	38	19	Healthy Blue / Blue Cross NC	North Carolina Medicaid	5.47	1.93	28.5
RBC	RBC	Laboratory & Pathology	85041	CPT	3001036		Washington Regional Medical Center	outpatient	38	19	Cigna	North Carolina PPO-PPA Direct	1.93	1.93	28.5
RBC	RBC	Laboratory & Pathology	85041	CPT	3001036		Washington Regional Medical Center	outpatient	38	19	Original Medicare	Traditional Medicare Fee-for-Service	17.86	1.93	28.5
RBC FOLATE	RBC FOLATE	Laboratory & Pathology	82747	CPT	3001639		Washington Regional Medical Center	outpatient	75	37.5	Self-Pay	Discounted Cash		11.22	56.25
RBC FOLATE	RBC FOLATE	Laboratory & Pathology	82747	CPT	3001639		Washington Regional Medical Center	outpatient	75	37.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	56.25	11.22	56.25
RBC FOLATE	RBC FOLATE	Laboratory & Pathology	82747	CPT	3001639		Washington Regional Medical Center	outpatient	75	37.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	33	11.22	56.25
RBC FOLATE	RBC FOLATE	Laboratory & Pathology	82747	CPT	3001639		Washington Regional Medical Center	outpatient	75	37.5	Humana	Medicare Advantage HMO/PPO/PFFS	35.25	11.22	56.25
RBC FOLATE	RBC FOLATE	Laboratory & Pathology	82747	CPT	3001639		Washington Regional Medical Center	outpatient	75	37.5	AmeriHealth Caritas North Carolina	NC Medicaid	27.49	11.22	56.25
RBC FOLATE	RBC FOLATE	Laboratory & Pathology	82747	CPT	3001639		Washington Regional Medical Center	outpatient	75	37.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	27.49	11.22	56.25
RBC FOLATE	RBC FOLATE	Laboratory & Pathology	82747	CPT	3001639		Washington Regional Medical Center	outpatient	75	37.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	27.49	11.22	56.25
RBC FOLATE	RBC FOLATE	Laboratory & Pathology	82747	CPT	3001639		Washington Regional Medical Center	outpatient	75	37.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	27.49	11.22	56.25
RBC FOLATE	RBC FOLATE	Laboratory & Pathology	82747	CPT	3001639		Washington Regional Medical Center	outpatient	75	37.5	Cigna	North Carolina PPO-PPA Direct	11.22	11.22	56.25
RBC FOLATE	RBC FOLATE	Laboratory & Pathology	82747	CPT	3001639		Washington Regional Medical Center	outpatient	75	37.5	Original Medicare	Traditional Medicare Fee-for-Service	35.25	11.22	56.25
SALICYLATE	SALICYLATE	Laboratory & Pathology	80179	CPT	3001026		Washington Regional Medical Center	outpatient	161	80.5	Self-Pay	Discounted Cash		9.29	120.75
SALICYLATE	SALICYLATE	Laboratory & Pathology	80179	CPT	3001026		Washington Regional Medical Center	outpatient	161	80.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	120.75	9.29	120.75
SALICYLATE	SALICYLATE	Laboratory & Pathology	80179	CPT	3001026		Washington Regional Medical Center	outpatient	161	80.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	70.84	9.29	120.75
SALICYLATE	SALICYLATE	Laboratory & Pathology	80179	CPT	3001026		Washington Regional Medical Center	outpatient	161	80.5	Humana	Medicare Advantage HMO/PPO/PFFS	75.67	9.29	120.75
SALICYLATE	SALICYLATE	Laboratory & Pathology	80179	CPT	3001026		Washington Regional Medical Center	outpatient	161	80.5	AmeriHealth Caritas North Carolina	NC Medicaid	56.61	9.29	120.75
SALICYLATE	SALICYLATE	Laboratory & Pathology	80179	CPT	3001026		Washington Regional Medical Center	outpatient	161	80.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	56.61	9.29	120.75
SALICYLATE	SALICYLATE	Laboratory & Pathology	80179	CPT	3001026		Washington Regional Medical Center	outpatient	161	80.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	56.61	9.29	120.75
SALICYLATE	SALICYLATE	Laboratory & Pathology	80179	CPT	3001026		Washington Regional Medical Center	outpatient	161	80.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	56.61	9.29	120.75
SALICYLATE	SALICYLATE	Laboratory & Pathology	80179	CPT	3001026		Washington Regional Medical Center	outpatient	161	80.5	Cigna	North Carolina PPO-PPA Direct	9.29	9.29	120.75
SALICYLATE	SALICYLATE	Laboratory & Pathology	80179	CPT	3001026		Washington Regional Medical Center	outpatient	161	80.5	Original Medicare	Traditional Medicare Fee-for-Service	75.67	9.29	120.75
SED RATE	SED RATE	Laboratory & Pathology	85651	CPT	3001041		Washington Regional Medical Center	outpatient	80	40	Self-Pay	Discounted Cash		3.65	60
SED RATE	SED RATE	Laboratory & Pathology	85651	CPT	3001041		Washington Regional Medical Center	outpatient	80	40	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	60	3.65	60
SED RATE	SED RATE	Laboratory & Pathology	85651	CPT	3001041		Washington Regional Medical Center	outpatient	80	40	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	35.2	3.65	60
SED RATE	SED RATE	Laboratory & Pathology	85651	CPT	3001041		Washington Regional Medical Center	outpatient	80	40	Humana	Medicare Advantage HMO/PPO/PFFS	37.6	3.65	60
SED RATE	SED RATE	Laboratory & Pathology	85651	CPT	3001041		Washington Regional Medical Center	outpatient	80	40	AmeriHealth Caritas North Carolina	NC Medicaid	6.47	3.65	60
SED RATE	SED RATE	Laboratory & Pathology	85651	CPT	3001041		Washington Regional Medical Center	outpatient	80	40	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	6.47	3.65	60
SED RATE	SED RATE	Laboratory & Pathology	85651	CPT	3001041		Washington Regional Medical Center	outpatient	80	40	WellCare of North Carolina	North Carolina Medicaid/CHIP	6.47	3.65	60
SED RATE	SED RATE	Laboratory & Pathology	85651	CPT	3001041		Washington Regional Medical Center	outpatient	80	40	Healthy Blue / Blue Cross NC	North Carolina Medicaid	6.47	3.65	60
SED RATE	SED RATE	Laboratory & Pathology	85651	CPT	3001041		Washington Regional Medical Center	outpatient	80	40	Cigna	North Carolina PPO-PPA Direct	3.65	3.65	60
SED RATE	SED RATE	Laboratory & Pathology	85651	CPT	3001041		Washington Regional Medical Center	outpatient	80	40	Original Medicare	Traditional Medicare Fee-for-Service	37.6	3.65	60
SGPT (ALT)	SGPT (ALT)	Laboratory & Pathology	84460	CPT	3001065		Washington Regional Medical Center	outpatient	83	41.5	Self-Pay	Discounted Cash		5.61	62.25
SGPT (ALT)	SGPT (ALT)	Laboratory & Pathology	84460	CPT	3001065		Washington Regional Medical Center	outpatient	83	41.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	62.25	5.61	62.25
SGPT (ALT)	SGPT (ALT)	Laboratory & Pathology	84460	CPT	3001065		Washington Regional Medical Center	outpatient	83	41.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	36.52	5.61	62.25
SGPT (ALT)	SGPT (ALT)	Laboratory & Pathology	84460	CPT	3001065		Washington Regional Medical Center	outpatient	83	41.5	Humana	Medicare Advantage HMO/PPO/PFFS	39.01	5.61	62.25
SGPT (ALT)	SGPT (ALT)	Laboratory & Pathology	84460	CPT	3001065		Washington Regional Medical Center	outpatient	83	41.5	AmeriHealth Caritas North Carolina	NC Medicaid	9.66	5.61	62.25
SGPT (ALT)	SGPT (ALT)	Laboratory & Pathology	84460	CPT	3001065		Washington Regional Medical Center	outpatient	83	41.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	9.66	5.61	62.25
SGPT (ALT)	SGPT (ALT)	Laboratory & Pathology	84460	CPT	3001065		Washington Regional Medical Center	outpatient	83	41.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	9.66	5.61	62.25
SGPT (ALT)	SGPT (ALT)	Laboratory & Pathology	84460	CPT	3001065		Washington Regional Medical Center	outpatient	83	41.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	9.66	5.61	62.25
SGPT (ALT)	SGPT (ALT)	Laboratory & Pathology	84460	CPT	3001065		Washington Regional Medical Center	outpatient	83	41.5	Cigna	North Carolina PPO-PPA Direct	5.61	5.61	62.25
SGPT (ALT)	SGPT (ALT)	Laboratory & Pathology	84460	CPT	3001065		Washington Regional Medical Center	outpatient	83	41.5	Original Medicare	Traditional Medicare Fee-for-Service	39.01	5.61	62.25
SJOGREN’S ANTIBODIES QUANT	SJOGREN’S ANTIBODIES QUANT	Laboratory & Pathology	86235	CPT	3001563		Washington Regional Medical Center	outpatient	71.72	35.86	Self-Pay	Discounted Cash		11.57	53.79
SJOGREN’S ANTIBODIES QUANT	SJOGREN’S ANTIBODIES QUANT	Laboratory & Pathology	86235	CPT	3001563		Washington Regional Medical Center	outpatient	71.72	35.86	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	53.79	11.57	53.79
SJOGREN’S ANTIBODIES QUANT	SJOGREN’S ANTIBODIES QUANT	Laboratory & Pathology	86235	CPT	3001563		Washington Regional Medical Center	outpatient	71.72	35.86	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	31.56	11.57	53.79
SJOGREN’S ANTIBODIES QUANT	SJOGREN’S ANTIBODIES QUANT	Laboratory & Pathology	86235	CPT	3001563		Washington Regional Medical Center	outpatient	71.72	35.86	Humana	Medicare Advantage HMO/PPO/PFFS	33.71	11.57	53.79
SJOGREN’S ANTIBODIES QUANT	SJOGREN’S ANTIBODIES QUANT	Laboratory & Pathology	86235	CPT	3001563		Washington Regional Medical Center	outpatient	71.72	35.86	AmeriHealth Caritas North Carolina	NC Medicaid	32.7	11.57	53.79
SJOGREN’S ANTIBODIES QUANT	SJOGREN’S ANTIBODIES QUANT	Laboratory & Pathology	86235	CPT	3001563		Washington Regional Medical Center	outpatient	71.72	35.86	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	32.7	11.57	53.79
SJOGREN’S ANTIBODIES QUANT	SJOGREN’S ANTIBODIES QUANT	Laboratory & Pathology	86235	CPT	3001563		Washington Regional Medical Center	outpatient	71.72	35.86	WellCare of North Carolina	North Carolina Medicaid/CHIP	32.7	11.57	53.79
SJOGREN’S ANTIBODIES QUANT	SJOGREN’S ANTIBODIES QUANT	Laboratory & Pathology	86235	CPT	3001563		Washington Regional Medical Center	outpatient	71.72	35.86	Healthy Blue / Blue Cross NC	North Carolina Medicaid	32.7	11.57	53.79
SJOGREN’S ANTIBODIES QUANT	SJOGREN’S ANTIBODIES QUANT	Laboratory & Pathology	86235	CPT	3001563		Washington Regional Medical Center	outpatient	71.72	35.86	Cigna	North Carolina PPO-PPA Direct	11.57	11.57	53.79
SJOGREN’S ANTIBODIES QUANT	SJOGREN’S ANTIBODIES QUANT	Laboratory & Pathology	86235	CPT	3001563		Washington Regional Medical Center	outpatient	71.72	35.86	Original Medicare	Traditional Medicare Fee-for-Service	33.71	11.57	53.79
SODIUM	SODIUM	Laboratory & Pathology	84295	CPT	3001025		Washington Regional Medical Center	outpatient	62	31	Self-Pay	Discounted Cash		3.15	46.5
SODIUM	SODIUM	Laboratory & Pathology	84295	CPT	3001025		Washington Regional Medical Center	outpatient	62	31	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	46.5	3.15	46.5
SODIUM	SODIUM	Laboratory & Pathology	84295	CPT	3001025		Washington Regional Medical Center	outpatient	62	31	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	27.28	3.15	46.5
SODIUM	SODIUM	Laboratory & Pathology	84295	CPT	3001025		Washington Regional Medical Center	outpatient	62	31	Humana	Medicare Advantage HMO/PPO/PFFS	29.14	3.15	46.5
SODIUM	SODIUM	Laboratory & Pathology	84295	CPT	3001025		Washington Regional Medical Center	outpatient	62	31	AmeriHealth Caritas North Carolina	NC Medicaid	8.78	3.15	46.5
SODIUM	SODIUM	Laboratory & Pathology	84295	CPT	3001025		Washington Regional Medical Center	outpatient	62	31	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	8.78	3.15	46.5
SODIUM	SODIUM	Laboratory & Pathology	84295	CPT	3001025		Washington Regional Medical Center	outpatient	62	31	WellCare of North Carolina	North Carolina Medicaid/CHIP	8.78	3.15	46.5
SODIUM	SODIUM	Laboratory & Pathology	84295	CPT	3001025		Washington Regional Medical Center	outpatient	62	31	Healthy Blue / Blue Cross NC	North Carolina Medicaid	8.78	3.15	46.5
SODIUM	SODIUM	Laboratory & Pathology	84295	CPT	3001025		Washington Regional Medical Center	outpatient	62	31	Cigna	North Carolina PPO-PPA Direct	3.15	3.15	46.5
SODIUM	SODIUM	Laboratory & Pathology	84295	CPT	3001025		Washington Regional Medical Center	outpatient	62	31	Original Medicare	Traditional Medicare Fee-for-Service	29.14	3.15	46.5
SP CHEMICAL HISTOCHEMISTRY	SP CHEMICAL HISTOCHEMISTRY	Laboratory & Pathology	88313	CPT	3002154		Washington Regional Medical Center	outpatient	141	70.5	Self-Pay	Discounted Cash		20.28	105.75
SP CHEMICAL HISTOCHEMISTRY	SP CHEMICAL HISTOCHEMISTRY	Laboratory & Pathology	88313	CPT	3002154		Washington Regional Medical Center	outpatient	141	70.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	105.75	20.28	105.75
SP CHEMICAL HISTOCHEMISTRY	SP CHEMICAL HISTOCHEMISTRY	Laboratory & Pathology	88313	CPT	3002154		Washington Regional Medical Center	outpatient	141	70.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	62.04	20.28	105.75
SP CHEMICAL HISTOCHEMISTRY	SP CHEMICAL HISTOCHEMISTRY	Laboratory & Pathology	88313	CPT	3002154		Washington Regional Medical Center	outpatient	141	70.5	Humana	Medicare Advantage HMO/PPO/PFFS	66.27	20.28	105.75
SP CHEMICAL HISTOCHEMISTRY	SP CHEMICAL HISTOCHEMISTRY	Laboratory & Pathology	88313	CPT	3002154		Washington Regional Medical Center	outpatient	141	70.5	AmeriHealth Caritas North Carolina	NC Medicaid	82.46	20.28	105.75
SP CHEMICAL HISTOCHEMISTRY	SP CHEMICAL HISTOCHEMISTRY	Laboratory & Pathology	88313	CPT	3002154		Washington Regional Medical Center	outpatient	141	70.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	82.46	20.28	105.75
SP CHEMICAL HISTOCHEMISTRY	SP CHEMICAL HISTOCHEMISTRY	Laboratory & Pathology	88313	CPT	3002154		Washington Regional Medical Center	outpatient	141	70.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	82.46	20.28	105.75
SP CHEMICAL HISTOCHEMISTRY	SP CHEMICAL HISTOCHEMISTRY	Laboratory & Pathology	88313	CPT	3002154		Washington Regional Medical Center	outpatient	141	70.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	82.46	20.28	105.75
SP CHEMICAL HISTOCHEMISTRY	SP CHEMICAL HISTOCHEMISTRY	Laboratory & Pathology	88313	CPT	3002154		Washington Regional Medical Center	outpatient	141	70.5	Cigna	North Carolina PPO-PPA Direct	20.28	20.28	105.75
SP CHEMICAL HISTOCHEMISTRY	SP CHEMICAL HISTOCHEMISTRY	Laboratory & Pathology	88313	CPT	3002154		Washington Regional Medical Center	outpatient	141	70.5	Original Medicare	Traditional Medicare Fee-for-Service	66.27	20.28	105.75
SPUTUM SPECIMEN COLLECTION	SPUTUM SPECIMEN COLLECTION	Laboratory & Pathology	89220	CPT	4001030		Washington Regional Medical Center	outpatient	201	100.5	Self-Pay	Discounted Cash		7.08	150.75
SPUTUM SPECIMEN COLLECTION	SPUTUM SPECIMEN COLLECTION	Laboratory & Pathology	89220	CPT	4001030		Washington Regional Medical Center	outpatient	201	100.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	150.75	7.08	150.75
SPUTUM SPECIMEN COLLECTION	SPUTUM SPECIMEN COLLECTION	Laboratory & Pathology	89220	CPT	4001030		Washington Regional Medical Center	outpatient	201	100.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	88.44	7.08	150.75
SPUTUM SPECIMEN COLLECTION	SPUTUM SPECIMEN COLLECTION	Laboratory & Pathology	89220	CPT	4001030		Washington Regional Medical Center	outpatient	201	100.5	Humana	Medicare Advantage HMO/PPO/PFFS	94.47	7.08	150.75
SPUTUM SPECIMEN COLLECTION	SPUTUM SPECIMEN COLLECTION	Laboratory & Pathology	89220	CPT	4001030		Washington Regional Medical Center	outpatient	201	100.5	AmeriHealth Caritas North Carolina	NC Medicaid	70.67	7.08	150.75
SPUTUM SPECIMEN COLLECTION	SPUTUM SPECIMEN COLLECTION	Laboratory & Pathology	89220	CPT	4001030		Washington Regional Medical Center	outpatient	201	100.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	70.67	7.08	150.75
SPUTUM SPECIMEN COLLECTION	SPUTUM SPECIMEN COLLECTION	Laboratory & Pathology	89220	CPT	4001030		Washington Regional Medical Center	outpatient	201	100.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	70.67	7.08	150.75
SPUTUM SPECIMEN COLLECTION	SPUTUM SPECIMEN COLLECTION	Laboratory & Pathology	89220	CPT	4001030		Washington Regional Medical Center	outpatient	201	100.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	70.67	7.08	150.75
SPUTUM SPECIMEN COLLECTION	SPUTUM SPECIMEN COLLECTION	Laboratory & Pathology	89220	CPT	4001030		Washington Regional Medical Center	outpatient	201	100.5	Cigna	North Carolina PPO-PPA Direct	7.08	7.08	150.75
SPUTUM SPECIMEN COLLECTION	SPUTUM SPECIMEN COLLECTION	Laboratory & Pathology	89220	CPT	4001030		Washington Regional Medical Center	outpatient	201	100.5	Original Medicare	Traditional Medicare Fee-for-Service	94.47	7.08	150.75
STIMULANTS, SYNTHETIC	STIMULANTS, SYNTHETIC	Laboratory & Pathology	80371	CPT	3002090		Washington Regional Medical Center	outpatient	243	121.5	Self-Pay	Discounted Cash		85.44	182.25
STIMULANTS, SYNTHETIC	STIMULANTS, SYNTHETIC	Laboratory & Pathology	80371	CPT	3002090		Washington Regional Medical Center	outpatient	243	121.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	182.25	85.44	182.25
STIMULANTS, SYNTHETIC	STIMULANTS, SYNTHETIC	Laboratory & Pathology	80371	CPT	3002090		Washington Regional Medical Center	outpatient	243	121.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	106.92	85.44	182.25
STIMULANTS, SYNTHETIC	STIMULANTS, SYNTHETIC	Laboratory & Pathology	80371	CPT	3002090		Washington Regional Medical Center	outpatient	243	121.5	Humana	Medicare Advantage HMO/PPO/PFFS	114.21	85.44	182.25
STIMULANTS, SYNTHETIC	STIMULANTS, SYNTHETIC	Laboratory & Pathology	80371	CPT	3002090		Washington Regional Medical Center	outpatient	243	121.5	AmeriHealth Caritas North Carolina	NC Medicaid	85.44	85.44	182.25
STIMULANTS, SYNTHETIC	STIMULANTS, SYNTHETIC	Laboratory & Pathology	80371	CPT	3002090		Washington Regional Medical Center	outpatient	243	121.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	85.44	85.44	182.25
STIMULANTS, SYNTHETIC	STIMULANTS, SYNTHETIC	Laboratory & Pathology	80371	CPT	3002090		Washington Regional Medical Center	outpatient	243	121.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	85.44	85.44	182.25
STIMULANTS, SYNTHETIC	STIMULANTS, SYNTHETIC	Laboratory & Pathology	80371	CPT	3002090		Washington Regional Medical Center	outpatient	243	121.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	85.44	85.44	182.25
STIMULANTS, SYNTHETIC	STIMULANTS, SYNTHETIC	Laboratory & Pathology	80371	CPT	3002090		Washington Regional Medical Center	outpatient	243	121.5	Original Medicare	Traditional Medicare Fee-for-Service	114.21	85.44	182.25
TACROLIMUS (FK 506)	TACROLIMUS (FK 506)	Laboratory & Pathology	80197	CPT	3001615		Washington Regional Medical Center	outpatient	105	52.5	Self-Pay	Discounted Cash		8.94	78.75
TACROLIMUS (FK 506)	TACROLIMUS (FK 506)	Laboratory & Pathology	80197	CPT	3001615		Washington Regional Medical Center	outpatient	105	52.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	78.75	8.94	78.75
TACROLIMUS (FK 506)	TACROLIMUS (FK 506)	Laboratory & Pathology	80197	CPT	3001615		Washington Regional Medical Center	outpatient	105	52.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	46.2	8.94	78.75
TACROLIMUS (FK 506)	TACROLIMUS (FK 506)	Laboratory & Pathology	80197	CPT	3001615		Washington Regional Medical Center	outpatient	105	52.5	Humana	Medicare Advantage HMO/PPO/PFFS	49.35	8.94	78.75
TACROLIMUS (FK 506)	TACROLIMUS (FK 506)	Laboratory & Pathology	80197	CPT	3001615		Washington Regional Medical Center	outpatient	105	52.5	AmeriHealth Caritas North Carolina	NC Medicaid	25.02	8.94	78.75
TACROLIMUS (FK 506)	TACROLIMUS (FK 506)	Laboratory & Pathology	80197	CPT	3001615		Washington Regional Medical Center	outpatient	105	52.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	25.02	8.94	78.75
TACROLIMUS (FK 506)	TACROLIMUS (FK 506)	Laboratory & Pathology	80197	CPT	3001615		Washington Regional Medical Center	outpatient	105	52.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	25.02	8.94	78.75
TACROLIMUS (FK 506)	TACROLIMUS (FK 506)	Laboratory & Pathology	80197	CPT	3001615		Washington Regional Medical Center	outpatient	105	52.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	25.02	8.94	78.75
TACROLIMUS (FK 506)	TACROLIMUS (FK 506)	Laboratory & Pathology	80197	CPT	3001615		Washington Regional Medical Center	outpatient	105	52.5	Cigna	North Carolina PPO-PPA Direct	8.94	8.94	78.75
TACROLIMUS (FK 506)	TACROLIMUS (FK 506)	Laboratory & Pathology	80197	CPT	3001615		Washington Regional Medical Center	outpatient	105	52.5	Original Medicare	Traditional Medicare Fee-for-Service	49.35	8.94	78.75
TESTOSTERONE TOTAL	TESTOSTERONE TOTAL	Laboratory & Pathology	84403	CPT	3001221		Washington Regional Medical Center	outpatient	168	84	Self-Pay	Discounted Cash		16.65	126
TESTOSTERONE TOTAL	TESTOSTERONE TOTAL	Laboratory & Pathology	84403	CPT	3001221		Washington Regional Medical Center	outpatient	168	84	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	126	16.65	126
TESTOSTERONE TOTAL	TESTOSTERONE TOTAL	Laboratory & Pathology	84403	CPT	3001221		Washington Regional Medical Center	outpatient	168	84	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	73.92	16.65	126
TESTOSTERONE TOTAL	TESTOSTERONE TOTAL	Laboratory & Pathology	84403	CPT	3001221		Washington Regional Medical Center	outpatient	168	84	Humana	Medicare Advantage HMO/PPO/PFFS	78.96	16.65	126
TESTOSTERONE TOTAL	TESTOSTERONE TOTAL	Laboratory & Pathology	84403	CPT	3001221		Washington Regional Medical Center	outpatient	168	84	AmeriHealth Caritas North Carolina	NC Medicaid	47.09	16.65	126
TESTOSTERONE TOTAL	TESTOSTERONE TOTAL	Laboratory & Pathology	84403	CPT	3001221		Washington Regional Medical Center	outpatient	168	84	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	47.09	16.65	126
TESTOSTERONE TOTAL	TESTOSTERONE TOTAL	Laboratory & Pathology	84403	CPT	3001221		Washington Regional Medical Center	outpatient	168	84	WellCare of North Carolina	North Carolina Medicaid/CHIP	47.09	16.65	126
TESTOSTERONE TOTAL	TESTOSTERONE TOTAL	Laboratory & Pathology	84403	CPT	3001221		Washington Regional Medical Center	outpatient	168	84	Healthy Blue / Blue Cross NC	North Carolina Medicaid	47.09	16.65	126
TESTOSTERONE TOTAL	TESTOSTERONE TOTAL	Laboratory & Pathology	84403	CPT	3001221		Washington Regional Medical Center	outpatient	168	84	Cigna	North Carolina PPO-PPA Direct	16.65	16.65	126
TESTOSTERONE TOTAL	TESTOSTERONE TOTAL	Laboratory & Pathology	84403	CPT	3001221		Washington Regional Medical Center	outpatient	168	84	Original Medicare	Traditional Medicare Fee-for-Service	78.96	16.65	126
TRICHROME STAIN	TRICHROME STAIN	Laboratory & Pathology	87209	CPT	3001655		Washington Regional Medical Center	outpatient	62	31	Self-Pay	Discounted Cash		12.09	46.5
TRICHROME STAIN	TRICHROME STAIN	Laboratory & Pathology	87209	CPT	3001655		Washington Regional Medical Center	outpatient	62	31	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	46.5	12.09	46.5
TRICHROME STAIN	TRICHROME STAIN	Laboratory & Pathology	87209	CPT	3001655		Washington Regional Medical Center	outpatient	62	31	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	27.28	12.09	46.5
TRICHROME STAIN	TRICHROME STAIN	Laboratory & Pathology	87209	CPT	3001655		Washington Regional Medical Center	outpatient	62	31	Humana	Medicare Advantage HMO/PPO/PFFS	29.14	12.09	46.5
TRICHROME STAIN	TRICHROME STAIN	Laboratory & Pathology	87209	CPT	3001655		Washington Regional Medical Center	outpatient	62	31	AmeriHealth Caritas North Carolina	NC Medicaid	32.77	12.09	46.5
TRICHROME STAIN	TRICHROME STAIN	Laboratory & Pathology	87209	CPT	3001655		Washington Regional Medical Center	outpatient	62	31	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	32.77	12.09	46.5
TRICHROME STAIN	TRICHROME STAIN	Laboratory & Pathology	87209	CPT	3001655		Washington Regional Medical Center	outpatient	62	31	WellCare of North Carolina	North Carolina Medicaid/CHIP	32.77	12.09	46.5
TRICHROME STAIN	TRICHROME STAIN	Laboratory & Pathology	87209	CPT	3001655		Washington Regional Medical Center	outpatient	62	31	Healthy Blue / Blue Cross NC	North Carolina Medicaid	32.77	12.09	46.5
TRICHROME STAIN	TRICHROME STAIN	Laboratory & Pathology	87209	CPT	3001655		Washington Regional Medical Center	outpatient	62	31	Cigna	North Carolina PPO-PPA Direct	12.09	12.09	46.5
TRICHROME STAIN	TRICHROME STAIN	Laboratory & Pathology	87209	CPT	3001655		Washington Regional Medical Center	outpatient	62	31	Original Medicare	Traditional Medicare Fee-for-Service	29.14	12.09	46.5
TRIIODOTHYRONINE T3 REVERSE	TRIIODOTHYRONINE T3 REVERSE	Laboratory & Pathology	84482	CPT	3002560		Washington Regional Medical Center	outpatient	75	37.5	Self-Pay	Discounted Cash		10.17	56.25
TRIIODOTHYRONINE T3 REVERSE	TRIIODOTHYRONINE T3 REVERSE	Laboratory & Pathology	84482	CPT	3002560		Washington Regional Medical Center	outpatient	75	37.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	56.25	10.17	56.25
TRIIODOTHYRONINE T3 REVERSE	TRIIODOTHYRONINE T3 REVERSE	Laboratory & Pathology	84482	CPT	3002560		Washington Regional Medical Center	outpatient	75	37.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	33	10.17	56.25
TRIIODOTHYRONINE T3 REVERSE	TRIIODOTHYRONINE T3 REVERSE	Laboratory & Pathology	84482	CPT	3002560		Washington Regional Medical Center	outpatient	75	37.5	Humana	Medicare Advantage HMO/PPO/PFFS	35.25	10.17	56.25
TRIIODOTHYRONINE T3 REVERSE	TRIIODOTHYRONINE T3 REVERSE	Laboratory & Pathology	84482	CPT	3002560		Washington Regional Medical Center	outpatient	75	37.5	AmeriHealth Caritas North Carolina	NC Medicaid	28.75	10.17	56.25
TRIIODOTHYRONINE T3 REVERSE	TRIIODOTHYRONINE T3 REVERSE	Laboratory & Pathology	84482	CPT	3002560		Washington Regional Medical Center	outpatient	75	37.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	28.75	10.17	56.25
TRIIODOTHYRONINE T3 REVERSE	TRIIODOTHYRONINE T3 REVERSE	Laboratory & Pathology	84482	CPT	3002560		Washington Regional Medical Center	outpatient	75	37.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	28.75	10.17	56.25
TRIIODOTHYRONINE T3 REVERSE	TRIIODOTHYRONINE T3 REVERSE	Laboratory & Pathology	84482	CPT	3002560		Washington Regional Medical Center	outpatient	75	37.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	28.75	10.17	56.25
TRIIODOTHYRONINE T3 REVERSE	TRIIODOTHYRONINE T3 REVERSE	Laboratory & Pathology	84482	CPT	3002560		Washington Regional Medical Center	outpatient	75	37.5	Cigna	North Carolina PPO-PPA Direct	10.17	10.17	56.25
TRIIODOTHYRONINE T3 REVERSE	TRIIODOTHYRONINE T3 REVERSE	Laboratory & Pathology	84482	CPT	3002560		Washington Regional Medical Center	outpatient	75	37.5	Original Medicare	Traditional Medicare Fee-for-Service	35.25	10.17	56.25
URIC ACID BODY FLUID	URIC ACID BODY FLUID	Laboratory & Pathology	84560	CPT	3001510		Washington Regional Medical Center	outpatient	55	27.5	Self-Pay	Discounted Cash		3.15	41.25
URIC ACID BODY FLUID	URIC ACID BODY FLUID	Laboratory & Pathology	84560	CPT	3001510		Washington Regional Medical Center	outpatient	55	27.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	41.25	3.15	41.25
URIC ACID BODY FLUID	URIC ACID BODY FLUID	Laboratory & Pathology	84560	CPT	3001510		Washington Regional Medical Center	outpatient	55	27.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	24.2	3.15	41.25
URIC ACID BODY FLUID	URIC ACID BODY FLUID	Laboratory & Pathology	84560	CPT	3001510		Washington Regional Medical Center	outpatient	55	27.5	Humana	Medicare Advantage HMO/PPO/PFFS	25.85	3.15	41.25
URIC ACID BODY FLUID	URIC ACID BODY FLUID	Laboratory & Pathology	84560	CPT	3001510		Washington Regional Medical Center	outpatient	55	27.5	AmeriHealth Caritas North Carolina	NC Medicaid	8.67	3.15	41.25
URIC ACID BODY FLUID	URIC ACID BODY FLUID	Laboratory & Pathology	84560	CPT	3001510		Washington Regional Medical Center	outpatient	55	27.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	8.67	3.15	41.25
URIC ACID BODY FLUID	URIC ACID BODY FLUID	Laboratory & Pathology	84560	CPT	3001510		Washington Regional Medical Center	outpatient	55	27.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	8.67	3.15	41.25
URIC ACID BODY FLUID	URIC ACID BODY FLUID	Laboratory & Pathology	84560	CPT	3001510		Washington Regional Medical Center	outpatient	55	27.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	8.67	3.15	41.25
URIC ACID BODY FLUID	URIC ACID BODY FLUID	Laboratory & Pathology	84560	CPT	3001510		Washington Regional Medical Center	outpatient	55	27.5	Cigna	North Carolina PPO-PPA Direct	3.15	3.15	41.25
URIC ACID BODY FLUID	URIC ACID BODY FLUID	Laboratory & Pathology	84560	CPT	3001510		Washington Regional Medical Center	outpatient	55	27.5	Original Medicare	Traditional Medicare Fee-for-Service	25.85	3.15	41.25
VALPROIC ACID; TOTAL	VALPROIC ACID; TOTAL	Laboratory & Pathology	80164	CPT	3001080		Washington Regional Medical Center	outpatient	168	84	Self-Pay	Discounted Cash		8.76	126
VALPROIC ACID; TOTAL	VALPROIC ACID; TOTAL	Laboratory & Pathology	80164	CPT	3001080		Washington Regional Medical Center	outpatient	168	84	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	126	8.76	126
VALPROIC ACID; TOTAL	VALPROIC ACID; TOTAL	Laboratory & Pathology	80164	CPT	3001080		Washington Regional Medical Center	outpatient	168	84	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	73.92	8.76	126
VALPROIC ACID; TOTAL	VALPROIC ACID; TOTAL	Laboratory & Pathology	80164	CPT	3001080		Washington Regional Medical Center	outpatient	168	84	Humana	Medicare Advantage HMO/PPO/PFFS	78.96	8.76	126
VALPROIC ACID; TOTAL	VALPROIC ACID; TOTAL	Laboratory & Pathology	80164	CPT	3001080		Washington Regional Medical Center	outpatient	168	84	AmeriHealth Caritas North Carolina	NC Medicaid	24.45	8.76	126
VALPROIC ACID; TOTAL	VALPROIC ACID; TOTAL	Laboratory & Pathology	80164	CPT	3001080		Washington Regional Medical Center	outpatient	168	84	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	24.45	8.76	126
VALPROIC ACID; TOTAL	VALPROIC ACID; TOTAL	Laboratory & Pathology	80164	CPT	3001080		Washington Regional Medical Center	outpatient	168	84	WellCare of North Carolina	North Carolina Medicaid/CHIP	24.45	8.76	126
VALPROIC ACID; TOTAL	VALPROIC ACID; TOTAL	Laboratory & Pathology	80164	CPT	3001080		Washington Regional Medical Center	outpatient	168	84	Healthy Blue / Blue Cross NC	North Carolina Medicaid	24.45	8.76	126
VALPROIC ACID; TOTAL	VALPROIC ACID; TOTAL	Laboratory & Pathology	80164	CPT	3001080		Washington Regional Medical Center	outpatient	168	84	Cigna	North Carolina PPO-PPA Direct	8.76	8.76	126
VALPROIC ACID; TOTAL	VALPROIC ACID; TOTAL	Laboratory & Pathology	80164	CPT	3001080		Washington Regional Medical Center	outpatient	168	84	Original Medicare	Traditional Medicare Fee-for-Service	78.96	8.76	126
VITAMIN B12	VITAMIN B12	Laboratory & Pathology	82607	CPT	3001523		Washington Regional Medical Center	outpatient	158	79	Self-Pay	Discounted Cash		9.82	118.5
VITAMIN B12	VITAMIN B12	Laboratory & Pathology	82607	CPT	3001523		Washington Regional Medical Center	outpatient	158	79	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	118.5	9.82	118.5
VITAMIN B12	VITAMIN B12	Laboratory & Pathology	82607	CPT	3001523		Washington Regional Medical Center	outpatient	158	79	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	69.52	9.82	118.5
VITAMIN B12	VITAMIN B12	Laboratory & Pathology	82607	CPT	3001523		Washington Regional Medical Center	outpatient	158	79	Humana	Medicare Advantage HMO/PPO/PFFS	74.26	9.82	118.5
VITAMIN B12	VITAMIN B12	Laboratory & Pathology	82607	CPT	3001523		Washington Regional Medical Center	outpatient	158	79	AmeriHealth Caritas North Carolina	NC Medicaid	27.49	9.82	118.5
VITAMIN B12	VITAMIN B12	Laboratory & Pathology	82607	CPT	3001523		Washington Regional Medical Center	outpatient	158	79	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	27.49	9.82	118.5
VITAMIN B12	VITAMIN B12	Laboratory & Pathology	82607	CPT	3001523		Washington Regional Medical Center	outpatient	158	79	WellCare of North Carolina	North Carolina Medicaid/CHIP	27.49	9.82	118.5
VITAMIN B12	VITAMIN B12	Laboratory & Pathology	82607	CPT	3001523		Washington Regional Medical Center	outpatient	158	79	Healthy Blue / Blue Cross NC	North Carolina Medicaid	27.49	9.82	118.5
VITAMIN B12	VITAMIN B12	Laboratory & Pathology	82607	CPT	3001523		Washington Regional Medical Center	outpatient	158	79	Cigna	North Carolina PPO-PPA Direct	9.82	9.82	118.5
VITAMIN B12	VITAMIN B12	Laboratory & Pathology	82607	CPT	3001523		Washington Regional Medical Center	outpatient	158	79	Original Medicare	Traditional Medicare Fee-for-Service	74.26	9.82	118.5
ZARONTIN (ETHOSUXIMIDE)	ZARONTIN (ETHOSUXIMIDE)	Laboratory & Pathology	80168	CPT	3001761		Washington Regional Medical Center	outpatient	184	92	Self-Pay	Discounted Cash		10.52	138
ZARONTIN (ETHOSUXIMIDE)	ZARONTIN (ETHOSUXIMIDE)	Laboratory & Pathology	80168	CPT	3001761		Washington Regional Medical Center	outpatient	184	92	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	138	10.52	138
ZARONTIN (ETHOSUXIMIDE)	ZARONTIN (ETHOSUXIMIDE)	Laboratory & Pathology	80168	CPT	3001761		Washington Regional Medical Center	outpatient	184	92	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	80.96	10.52	138
ZARONTIN (ETHOSUXIMIDE)	ZARONTIN (ETHOSUXIMIDE)	Laboratory & Pathology	80168	CPT	3001761		Washington Regional Medical Center	outpatient	184	92	Humana	Medicare Advantage HMO/PPO/PFFS	86.48	10.52	138
ZARONTIN (ETHOSUXIMIDE)	ZARONTIN (ETHOSUXIMIDE)	Laboratory & Pathology	80168	CPT	3001761		Washington Regional Medical Center	outpatient	184	92	AmeriHealth Caritas North Carolina	NC Medicaid	29.8	10.52	138
ZARONTIN (ETHOSUXIMIDE)	ZARONTIN (ETHOSUXIMIDE)	Laboratory & Pathology	80168	CPT	3001761		Washington Regional Medical Center	outpatient	184	92	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	29.8	10.52	138
ZARONTIN (ETHOSUXIMIDE)	ZARONTIN (ETHOSUXIMIDE)	Laboratory & Pathology	80168	CPT	3001761		Washington Regional Medical Center	outpatient	184	92	WellCare of North Carolina	North Carolina Medicaid/CHIP	29.8	10.52	138
ZARONTIN (ETHOSUXIMIDE)	ZARONTIN (ETHOSUXIMIDE)	Laboratory & Pathology	80168	CPT	3001761		Washington Regional Medical Center	outpatient	184	92	Healthy Blue / Blue Cross NC	North Carolina Medicaid	29.8	10.52	138
ZARONTIN (ETHOSUXIMIDE)	ZARONTIN (ETHOSUXIMIDE)	Laboratory & Pathology	80168	CPT	3001761		Washington Regional Medical Center	outpatient	184	92	Cigna	North Carolina PPO-PPA Direct	10.52	10.52	138
ZARONTIN (ETHOSUXIMIDE)	ZARONTIN (ETHOSUXIMIDE)	Laboratory & Pathology	80168	CPT	3001761		Washington Regional Medical Center	outpatient	184	92	Original Medicare	Traditional Medicare Fee-for-Service	86.48	10.52	138
1ST COVID	1ST COVID	Medicine	91300	CPT	8001770		Washington Regional Medical Center	outpatient	53	26.5	Self-Pay	Discounted Cash		18.63	39.75
1ST COVID	1ST COVID	Medicine	91300	CPT	8001770		Washington Regional Medical Center	outpatient	53	26.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	39.75	18.63	39.75
1ST COVID	1ST COVID	Medicine	91300	CPT	8001770		Washington Regional Medical Center	outpatient	53	26.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	23.32	18.63	39.75
1ST COVID	1ST COVID	Medicine	91300	CPT	8001770		Washington Regional Medical Center	outpatient	53	26.5	Humana	Medicare Advantage HMO/PPO/PFFS	24.91	18.63	39.75
1ST COVID	1ST COVID	Medicine	91300	CPT	8001770		Washington Regional Medical Center	outpatient	53	26.5	AmeriHealth Caritas North Carolina	NC Medicaid	18.63	18.63	39.75
1ST COVID	1ST COVID	Medicine	91300	CPT	8001770		Washington Regional Medical Center	outpatient	53	26.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	18.63	18.63	39.75
1ST COVID	1ST COVID	Medicine	91300	CPT	8001770		Washington Regional Medical Center	outpatient	53	26.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	18.63	18.63	39.75
1ST COVID	1ST COVID	Medicine	91300	CPT	8001770		Washington Regional Medical Center	outpatient	53	26.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	18.63	18.63	39.75
1ST COVID	1ST COVID	Medicine	91300	CPT	8001770		Washington Regional Medical Center	outpatient	53	26.5	Original Medicare	Traditional Medicare Fee-for-Service	24.91	18.63	39.75
2nd dose covid vaccine	2nd dose covid vaccine	Medicine	91300	CPT	8001565		Washington Regional Medical Center	outpatient	28.39	14.2	Self-Pay	Discounted Cash		9.98	21.29
2nd dose covid vaccine	2nd dose covid vaccine	Medicine	91300	CPT	8001565		Washington Regional Medical Center	outpatient	28.39	14.2	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	21.29	9.98	21.29
2nd dose covid vaccine	2nd dose covid vaccine	Medicine	91300	CPT	8001565		Washington Regional Medical Center	outpatient	28.39	14.2	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	12.49	9.98	21.29
2nd dose covid vaccine	2nd dose covid vaccine	Medicine	91300	CPT	8001565		Washington Regional Medical Center	outpatient	28.39	14.2	Humana	Medicare Advantage HMO/PPO/PFFS	13.34	9.98	21.29
2nd dose covid vaccine	2nd dose covid vaccine	Medicine	91300	CPT	8001565		Washington Regional Medical Center	outpatient	28.39	14.2	AmeriHealth Caritas North Carolina	NC Medicaid	9.98	9.98	21.29
2nd dose covid vaccine	2nd dose covid vaccine	Medicine	91300	CPT	8001565		Washington Regional Medical Center	outpatient	28.39	14.2	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	9.98	9.98	21.29
2nd dose covid vaccine	2nd dose covid vaccine	Medicine	91300	CPT	8001565		Washington Regional Medical Center	outpatient	28.39	14.2	WellCare of North Carolina	North Carolina Medicaid/CHIP	9.98	9.98	21.29
2nd dose covid vaccine	2nd dose covid vaccine	Medicine	91300	CPT	8001565		Washington Regional Medical Center	outpatient	28.39	14.2	Healthy Blue / Blue Cross NC	North Carolina Medicaid	9.98	9.98	21.29
2nd dose covid vaccine	2nd dose covid vaccine	Medicine	91300	CPT	8001565		Washington Regional Medical Center	outpatient	28.39	14.2	Original Medicare	Traditional Medicare Fee-for-Service	13.34	9.98	21.29
95992-PHYS THER EPLY MANUEVER	95992-PHYS THER EPLY MANUEVER	Medicine	95992	CPT	8010329		Washington Regional Medical Center	outpatient	116	58	Self-Pay	Discounted Cash		32.02	87
95992-PHYS THER EPLY MANUEVER	95992-PHYS THER EPLY MANUEVER	Medicine	95992	CPT	8010329		Washington Regional Medical Center	outpatient	116	58	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	87	32.02	87
95992-PHYS THER EPLY MANUEVER	95992-PHYS THER EPLY MANUEVER	Medicine	95992	CPT	8010329		Washington Regional Medical Center	outpatient	116	58	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	51.04	32.02	87
95992-PHYS THER EPLY MANUEVER	95992-PHYS THER EPLY MANUEVER	Medicine	95992	CPT	8010329		Washington Regional Medical Center	outpatient	116	58	Humana	Medicare Advantage HMO/PPO/PFFS	54.52	32.02	87
95992-PHYS THER EPLY MANUEVER	95992-PHYS THER EPLY MANUEVER	Medicine	95992	CPT	8010329		Washington Regional Medical Center	outpatient	116	58	AmeriHealth Caritas North Carolina	NC Medicaid	40.79	32.02	87
95992-PHYS THER EPLY MANUEVER	95992-PHYS THER EPLY MANUEVER	Medicine	95992	CPT	8010329		Washington Regional Medical Center	outpatient	116	58	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	40.79	32.02	87
95992-PHYS THER EPLY MANUEVER	95992-PHYS THER EPLY MANUEVER	Medicine	95992	CPT	8010329		Washington Regional Medical Center	outpatient	116	58	WellCare of North Carolina	North Carolina Medicaid/CHIP	40.79	32.02	87
95992-PHYS THER EPLY MANUEVER	95992-PHYS THER EPLY MANUEVER	Medicine	95992	CPT	8010329		Washington Regional Medical Center	outpatient	116	58	Healthy Blue / Blue Cross NC	North Carolina Medicaid	40.79	32.02	87
95992-PHYS THER EPLY MANUEVER	95992-PHYS THER EPLY MANUEVER	Medicine	95992	CPT	8010329		Washington Regional Medical Center	outpatient	116	58	Cigna	North Carolina PPO-PPA Direct	32.02	32.02	87
95992-PHYS THER EPLY MANUEVER	95992-PHYS THER EPLY MANUEVER	Medicine	95992	CPT	8010329		Washington Regional Medical Center	outpatient	116	58	Original Medicare	Traditional Medicare Fee-for-Service	54.52	32.02	87
97012-PHYS THER MECHANCL TRACT	97012-PHYS THER MECHANCL TRACT	Medicine	97012	CPT	8010351		Washington Regional Medical Center	outpatient	99	49.5	Self-Pay	Discounted Cash		12.13	74.25
97012-PHYS THER MECHANCL TRACT	97012-PHYS THER MECHANCL TRACT	Medicine	97012	CPT	8010351		Washington Regional Medical Center	outpatient	99	49.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	74.25	12.13	74.25
97012-PHYS THER MECHANCL TRACT	97012-PHYS THER MECHANCL TRACT	Medicine	97012	CPT	8010351		Washington Regional Medical Center	outpatient	99	49.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	43.56	12.13	74.25
97012-PHYS THER MECHANCL TRACT	97012-PHYS THER MECHANCL TRACT	Medicine	97012	CPT	8010351		Washington Regional Medical Center	outpatient	99	49.5	Humana	Medicare Advantage HMO/PPO/PFFS	46.53	12.13	74.25
97012-PHYS THER MECHANCL TRACT	97012-PHYS THER MECHANCL TRACT	Medicine	97012	CPT	8010351		Washington Regional Medical Center	outpatient	99	49.5	AmeriHealth Caritas North Carolina	NC Medicaid	34.81	12.13	74.25
97012-PHYS THER MECHANCL TRACT	97012-PHYS THER MECHANCL TRACT	Medicine	97012	CPT	8010351		Washington Regional Medical Center	outpatient	99	49.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	34.81	12.13	74.25
97012-PHYS THER MECHANCL TRACT	97012-PHYS THER MECHANCL TRACT	Medicine	97012	CPT	8010351		Washington Regional Medical Center	outpatient	99	49.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	34.81	12.13	74.25
97012-PHYS THER MECHANCL TRACT	97012-PHYS THER MECHANCL TRACT	Medicine	97012	CPT	8010351		Washington Regional Medical Center	outpatient	99	49.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	34.81	12.13	74.25
97012-PHYS THER MECHANCL TRACT	97012-PHYS THER MECHANCL TRACT	Medicine	97012	CPT	8010351		Washington Regional Medical Center	outpatient	99	49.5	Cigna	North Carolina PPO-PPA Direct	12.13	12.13	74.25
97012-PHYS THER MECHANCL TRACT	97012-PHYS THER MECHANCL TRACT	Medicine	97012	CPT	8010351		Washington Regional Medical Center	outpatient	99	49.5	Original Medicare	Traditional Medicare Fee-for-Service	46.53	12.13	74.25
97016-OCC THER VASOPNEUMATIC D	97016-OCC THER VASOPNEUMATIC D	Medicine	97016	CPT	10774930		Washington Regional Medical Center	outpatient	60	30	Self-Pay	Discounted Cash		11.37	45
97016-OCC THER VASOPNEUMATIC D	97016-OCC THER VASOPNEUMATIC D	Medicine	97016	CPT	10774930		Washington Regional Medical Center	outpatient	60	30	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	45	11.37	45
97016-OCC THER VASOPNEUMATIC D	97016-OCC THER VASOPNEUMATIC D	Medicine	97016	CPT	10774930		Washington Regional Medical Center	outpatient	60	30	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	26.4	11.37	45
97016-OCC THER VASOPNEUMATIC D	97016-OCC THER VASOPNEUMATIC D	Medicine	97016	CPT	10774930		Washington Regional Medical Center	outpatient	60	30	Humana	Medicare Advantage HMO/PPO/PFFS	28.2	11.37	45
97016-OCC THER VASOPNEUMATIC D	97016-OCC THER VASOPNEUMATIC D	Medicine	97016	CPT	10774930		Washington Regional Medical Center	outpatient	60	30	AmeriHealth Caritas North Carolina	NC Medicaid	21.1	11.37	45
97016-OCC THER VASOPNEUMATIC D	97016-OCC THER VASOPNEUMATIC D	Medicine	97016	CPT	10774930		Washington Regional Medical Center	outpatient	60	30	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	21.1	11.37	45
97016-OCC THER VASOPNEUMATIC D	97016-OCC THER VASOPNEUMATIC D	Medicine	97016	CPT	10774930		Washington Regional Medical Center	outpatient	60	30	WellCare of North Carolina	North Carolina Medicaid/CHIP	21.1	11.37	45
97016-OCC THER VASOPNEUMATIC D	97016-OCC THER VASOPNEUMATIC D	Medicine	97016	CPT	10774930		Washington Regional Medical Center	outpatient	60	30	Healthy Blue / Blue Cross NC	North Carolina Medicaid	21.1	11.37	45
97016-OCC THER VASOPNEUMATIC D	97016-OCC THER VASOPNEUMATIC D	Medicine	97016	CPT	10774930		Washington Regional Medical Center	outpatient	60	30	Cigna	North Carolina PPO-PPA Direct	11.37	11.37	45
97016-OCC THER VASOPNEUMATIC D	97016-OCC THER VASOPNEUMATIC D	Medicine	97016	CPT	10774930		Washington Regional Medical Center	outpatient	60	30	Original Medicare	Traditional Medicare Fee-for-Service	28.2	11.37	45
97016-PHYS THER VASOPNEUM DEV	97016-PHYS THER VASOPNEUM DEV	Medicine	97016	CPT	10774929		Washington Regional Medical Center	outpatient	60	30	Self-Pay	Discounted Cash		11.37	45
97016-PHYS THER VASOPNEUM DEV	97016-PHYS THER VASOPNEUM DEV	Medicine	97016	CPT	10774929		Washington Regional Medical Center	outpatient	60	30	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	45	11.37	45
97016-PHYS THER VASOPNEUM DEV	97016-PHYS THER VASOPNEUM DEV	Medicine	97016	CPT	10774929		Washington Regional Medical Center	outpatient	60	30	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	26.4	11.37	45
97016-PHYS THER VASOPNEUM DEV	97016-PHYS THER VASOPNEUM DEV	Medicine	97016	CPT	10774929		Washington Regional Medical Center	outpatient	60	30	Humana	Medicare Advantage HMO/PPO/PFFS	28.2	11.37	45
97016-PHYS THER VASOPNEUM DEV	97016-PHYS THER VASOPNEUM DEV	Medicine	97016	CPT	10774929		Washington Regional Medical Center	outpatient	60	30	AmeriHealth Caritas North Carolina	NC Medicaid	21.1	11.37	45
97016-PHYS THER VASOPNEUM DEV	97016-PHYS THER VASOPNEUM DEV	Medicine	97016	CPT	10774929		Washington Regional Medical Center	outpatient	60	30	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	21.1	11.37	45
97016-PHYS THER VASOPNEUM DEV	97016-PHYS THER VASOPNEUM DEV	Medicine	97016	CPT	10774929		Washington Regional Medical Center	outpatient	60	30	WellCare of North Carolina	North Carolina Medicaid/CHIP	21.1	11.37	45
97016-PHYS THER VASOPNEUM DEV	97016-PHYS THER VASOPNEUM DEV	Medicine	97016	CPT	10774929		Washington Regional Medical Center	outpatient	60	30	Healthy Blue / Blue Cross NC	North Carolina Medicaid	21.1	11.37	45
97016-PHYS THER VASOPNEUM DEV	97016-PHYS THER VASOPNEUM DEV	Medicine	97016	CPT	10774929		Washington Regional Medical Center	outpatient	60	30	Cigna	North Carolina PPO-PPA Direct	11.37	11.37	45
97016-PHYS THER VASOPNEUM DEV	97016-PHYS THER VASOPNEUM DEV	Medicine	97016	CPT	10774929		Washington Regional Medical Center	outpatient	60	30	Original Medicare	Traditional Medicare Fee-for-Service	28.2	11.37	45
97026-OCC THER TX INFRARED THE	97026-OCC THER TX INFRARED THE	Medicine	97026	CPT	8010300		Washington Regional Medical Center	outpatient	43	21.5	Self-Pay	Discounted Cash		3.93	32.25
97026-OCC THER TX INFRARED THE	97026-OCC THER TX INFRARED THE	Medicine	97026	CPT	8010300		Washington Regional Medical Center	outpatient	43	21.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	32.25	3.93	32.25
97026-OCC THER TX INFRARED THE	97026-OCC THER TX INFRARED THE	Medicine	97026	CPT	8010300		Washington Regional Medical Center	outpatient	43	21.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	18.92	3.93	32.25
97026-OCC THER TX INFRARED THE	97026-OCC THER TX INFRARED THE	Medicine	97026	CPT	8010300		Washington Regional Medical Center	outpatient	43	21.5	Humana	Medicare Advantage HMO/PPO/PFFS	20.21	3.93	32.25
97026-OCC THER TX INFRARED THE	97026-OCC THER TX INFRARED THE	Medicine	97026	CPT	8010300		Washington Regional Medical Center	outpatient	43	21.5	AmeriHealth Caritas North Carolina	NC Medicaid	15.12	3.93	32.25
97026-OCC THER TX INFRARED THE	97026-OCC THER TX INFRARED THE	Medicine	97026	CPT	8010300		Washington Regional Medical Center	outpatient	43	21.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	15.12	3.93	32.25
97026-OCC THER TX INFRARED THE	97026-OCC THER TX INFRARED THE	Medicine	97026	CPT	8010300		Washington Regional Medical Center	outpatient	43	21.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	15.12	3.93	32.25
97026-OCC THER TX INFRARED THE	97026-OCC THER TX INFRARED THE	Medicine	97026	CPT	8010300		Washington Regional Medical Center	outpatient	43	21.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	15.12	3.93	32.25
97026-OCC THER TX INFRARED THE	97026-OCC THER TX INFRARED THE	Medicine	97026	CPT	8010300		Washington Regional Medical Center	outpatient	43	21.5	Cigna	North Carolina PPO-PPA Direct	3.93	3.93	32.25
97026-OCC THER TX INFRARED THE	97026-OCC THER TX INFRARED THE	Medicine	97026	CPT	8010300		Washington Regional Medical Center	outpatient	43	21.5	Original Medicare	Traditional Medicare Fee-for-Service	20.21	3.93	32.25
97026-PHYS THER TX INFRARED TH	97026-PHYS THER TX INFRARED TH	Medicine	97026	CPT	8010400		Washington Regional Medical Center	outpatient	6.21	3.11	Self-Pay	Discounted Cash		2.18	4.66
97026-PHYS THER TX INFRARED TH	97026-PHYS THER TX INFRARED TH	Medicine	97026	CPT	8010400		Washington Regional Medical Center	outpatient	6.21	3.11	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	4.66	2.18	4.66
97026-PHYS THER TX INFRARED TH	97026-PHYS THER TX INFRARED TH	Medicine	97026	CPT	8010400		Washington Regional Medical Center	outpatient	6.21	3.11	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	2.73	2.18	4.66
97026-PHYS THER TX INFRARED TH	97026-PHYS THER TX INFRARED TH	Medicine	97026	CPT	8010400		Washington Regional Medical Center	outpatient	6.21	3.11	Humana	Medicare Advantage HMO/PPO/PFFS	2.92	2.18	4.66
97026-PHYS THER TX INFRARED TH	97026-PHYS THER TX INFRARED TH	Medicine	97026	CPT	8010400		Washington Regional Medical Center	outpatient	6.21	3.11	AmeriHealth Caritas North Carolina	NC Medicaid	2.18	2.18	4.66
97026-PHYS THER TX INFRARED TH	97026-PHYS THER TX INFRARED TH	Medicine	97026	CPT	8010400		Washington Regional Medical Center	outpatient	6.21	3.11	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	2.18	2.18	4.66
97026-PHYS THER TX INFRARED TH	97026-PHYS THER TX INFRARED TH	Medicine	97026	CPT	8010400		Washington Regional Medical Center	outpatient	6.21	3.11	WellCare of North Carolina	North Carolina Medicaid/CHIP	2.18	2.18	4.66
97026-PHYS THER TX INFRARED TH	97026-PHYS THER TX INFRARED TH	Medicine	97026	CPT	8010400		Washington Regional Medical Center	outpatient	6.21	3.11	Healthy Blue / Blue Cross NC	North Carolina Medicaid	2.18	2.18	4.66
97026-PHYS THER TX INFRARED TH	97026-PHYS THER TX INFRARED TH	Medicine	97026	CPT	8010400		Washington Regional Medical Center	outpatient	6.21	3.11	Cigna	North Carolina PPO-PPA Direct	3.93	2.18	4.66
97026-PHYS THER TX INFRARED TH	97026-PHYS THER TX INFRARED TH	Medicine	97026	CPT	8010400		Washington Regional Medical Center	outpatient	6.21	3.11	Original Medicare	Traditional Medicare Fee-for-Service	2.92	2.18	4.66
97033-OCC THER IONTOPHORESIS 1	97033-OCC THER IONTOPHORESIS 1	Medicine	97033	CPT	8010233		Washington Regional Medical Center	outpatient	140	70	Self-Pay	Discounted Cash		16.63	105
97033-OCC THER IONTOPHORESIS 1	97033-OCC THER IONTOPHORESIS 1	Medicine	97033	CPT	8010233		Washington Regional Medical Center	outpatient	140	70	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	105	16.63	105
97033-OCC THER IONTOPHORESIS 1	97033-OCC THER IONTOPHORESIS 1	Medicine	97033	CPT	8010233		Washington Regional Medical Center	outpatient	140	70	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	61.6	16.63	105
97033-OCC THER IONTOPHORESIS 1	97033-OCC THER IONTOPHORESIS 1	Medicine	97033	CPT	8010233		Washington Regional Medical Center	outpatient	140	70	Humana	Medicare Advantage HMO/PPO/PFFS	65.8	16.63	105
97033-OCC THER IONTOPHORESIS 1	97033-OCC THER IONTOPHORESIS 1	Medicine	97033	CPT	8010233		Washington Regional Medical Center	outpatient	140	70	AmeriHealth Caritas North Carolina	NC Medicaid	49.22	16.63	105
97033-OCC THER IONTOPHORESIS 1	97033-OCC THER IONTOPHORESIS 1	Medicine	97033	CPT	8010233		Washington Regional Medical Center	outpatient	140	70	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	49.22	16.63	105
97033-OCC THER IONTOPHORESIS 1	97033-OCC THER IONTOPHORESIS 1	Medicine	97033	CPT	8010233		Washington Regional Medical Center	outpatient	140	70	WellCare of North Carolina	North Carolina Medicaid/CHIP	49.22	16.63	105
97033-OCC THER IONTOPHORESIS 1	97033-OCC THER IONTOPHORESIS 1	Medicine	97033	CPT	8010233		Washington Regional Medical Center	outpatient	140	70	Healthy Blue / Blue Cross NC	North Carolina Medicaid	49.22	16.63	105
97033-OCC THER IONTOPHORESIS 1	97033-OCC THER IONTOPHORESIS 1	Medicine	97033	CPT	8010233		Washington Regional Medical Center	outpatient	140	70	Cigna	North Carolina PPO-PPA Direct	16.63	16.63	105
97033-OCC THER IONTOPHORESIS 1	97033-OCC THER IONTOPHORESIS 1	Medicine	97033	CPT	8010233		Washington Regional Medical Center	outpatient	140	70	Original Medicare	Traditional Medicare Fee-for-Service	65.8	16.63	105
97033-PHYS THER IONTOPHORES15m	97033-PHYS THER IONTOPHORES15m	Medicine	97033	CPT	8010342		Washington Regional Medical Center	outpatient	140	70	Self-Pay	Discounted Cash		16.63	105
97033-PHYS THER IONTOPHORES15m	97033-PHYS THER IONTOPHORES15m	Medicine	97033	CPT	8010342		Washington Regional Medical Center	outpatient	140	70	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	105	16.63	105
97033-PHYS THER IONTOPHORES15m	97033-PHYS THER IONTOPHORES15m	Medicine	97033	CPT	8010342		Washington Regional Medical Center	outpatient	140	70	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	61.6	16.63	105
97033-PHYS THER IONTOPHORES15m	97033-PHYS THER IONTOPHORES15m	Medicine	97033	CPT	8010342		Washington Regional Medical Center	outpatient	140	70	Humana	Medicare Advantage HMO/PPO/PFFS	65.8	16.63	105
97033-PHYS THER IONTOPHORES15m	97033-PHYS THER IONTOPHORES15m	Medicine	97033	CPT	8010342		Washington Regional Medical Center	outpatient	140	70	AmeriHealth Caritas North Carolina	NC Medicaid	49.22	16.63	105
97033-PHYS THER IONTOPHORES15m	97033-PHYS THER IONTOPHORES15m	Medicine	97033	CPT	8010342		Washington Regional Medical Center	outpatient	140	70	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	49.22	16.63	105
97033-PHYS THER IONTOPHORES15m	97033-PHYS THER IONTOPHORES15m	Medicine	97033	CPT	8010342		Washington Regional Medical Center	outpatient	140	70	WellCare of North Carolina	North Carolina Medicaid/CHIP	49.22	16.63	105
97033-PHYS THER IONTOPHORES15m	97033-PHYS THER IONTOPHORES15m	Medicine	97033	CPT	8010342		Washington Regional Medical Center	outpatient	140	70	Healthy Blue / Blue Cross NC	North Carolina Medicaid	49.22	16.63	105
97033-PHYS THER IONTOPHORES15m	97033-PHYS THER IONTOPHORES15m	Medicine	97033	CPT	8010342		Washington Regional Medical Center	outpatient	140	70	Cigna	North Carolina PPO-PPA Direct	16.63	16.63	105
97033-PHYS THER IONTOPHORES15m	97033-PHYS THER IONTOPHORES15m	Medicine	97033	CPT	8010342		Washington Regional Medical Center	outpatient	140	70	Original Medicare	Traditional Medicare Fee-for-Service	65.8	16.63	105
97112-OCC THER NEUROMUSC RE-ED	97112-OCC THER NEUROMUSC RE-ED	Medicine	97112	CPT	8010248		Washington Regional Medical Center	outpatient	146	73	Self-Pay	Discounted Cash		24.15	109.5
97112-OCC THER NEUROMUSC RE-ED	97112-OCC THER NEUROMUSC RE-ED	Medicine	97112	CPT	8010248		Washington Regional Medical Center	outpatient	146	73	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	109.5	24.15	109.5
97112-OCC THER NEUROMUSC RE-ED	97112-OCC THER NEUROMUSC RE-ED	Medicine	97112	CPT	8010248		Washington Regional Medical Center	outpatient	146	73	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	64.24	24.15	109.5
97112-OCC THER NEUROMUSC RE-ED	97112-OCC THER NEUROMUSC RE-ED	Medicine	97112	CPT	8010248		Washington Regional Medical Center	outpatient	146	73	Humana	Medicare Advantage HMO/PPO/PFFS	68.62	24.15	109.5
97112-OCC THER NEUROMUSC RE-ED	97112-OCC THER NEUROMUSC RE-ED	Medicine	97112	CPT	8010248		Washington Regional Medical Center	outpatient	146	73	AmeriHealth Caritas North Carolina	NC Medicaid	51.33	24.15	109.5
97112-OCC THER NEUROMUSC RE-ED	97112-OCC THER NEUROMUSC RE-ED	Medicine	97112	CPT	8010248		Washington Regional Medical Center	outpatient	146	73	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	51.33	24.15	109.5
97112-OCC THER NEUROMUSC RE-ED	97112-OCC THER NEUROMUSC RE-ED	Medicine	97112	CPT	8010248		Washington Regional Medical Center	outpatient	146	73	WellCare of North Carolina	North Carolina Medicaid/CHIP	51.33	24.15	109.5
97112-OCC THER NEUROMUSC RE-ED	97112-OCC THER NEUROMUSC RE-ED	Medicine	97112	CPT	8010248		Washington Regional Medical Center	outpatient	146	73	Healthy Blue / Blue Cross NC	North Carolina Medicaid	51.33	24.15	109.5
97112-OCC THER NEUROMUSC RE-ED	97112-OCC THER NEUROMUSC RE-ED	Medicine	97112	CPT	8010248		Washington Regional Medical Center	outpatient	146	73	Cigna	North Carolina PPO-PPA Direct	24.15	24.15	109.5
97112-OCC THER NEUROMUSC RE-ED	97112-OCC THER NEUROMUSC RE-ED	Medicine	97112	CPT	8010248		Washington Regional Medical Center	outpatient	146	73	Original Medicare	Traditional Medicare Fee-for-Service	68.62	24.15	109.5
97112-PHYS THER NRMSC RE-E 15m	97112-PHYS THER NRMSC RE-E 15m	Medicine	97112	CPT	8010357		Washington Regional Medical Center	outpatient	146	73	Self-Pay	Discounted Cash		24.15	109.5
97112-PHYS THER NRMSC RE-E 15m	97112-PHYS THER NRMSC RE-E 15m	Medicine	97112	CPT	8010357		Washington Regional Medical Center	outpatient	146	73	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	109.5	24.15	109.5
97112-PHYS THER NRMSC RE-E 15m	97112-PHYS THER NRMSC RE-E 15m	Medicine	97112	CPT	8010357		Washington Regional Medical Center	outpatient	146	73	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	64.24	24.15	109.5
97112-PHYS THER NRMSC RE-E 15m	97112-PHYS THER NRMSC RE-E 15m	Medicine	97112	CPT	8010357		Washington Regional Medical Center	outpatient	146	73	Humana	Medicare Advantage HMO/PPO/PFFS	68.62	24.15	109.5
97112-PHYS THER NRMSC RE-E 15m	97112-PHYS THER NRMSC RE-E 15m	Medicine	97112	CPT	8010357		Washington Regional Medical Center	outpatient	146	73	AmeriHealth Caritas North Carolina	NC Medicaid	51.33	24.15	109.5
97112-PHYS THER NRMSC RE-E 15m	97112-PHYS THER NRMSC RE-E 15m	Medicine	97112	CPT	8010357		Washington Regional Medical Center	outpatient	146	73	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	51.33	24.15	109.5
97112-PHYS THER NRMSC RE-E 15m	97112-PHYS THER NRMSC RE-E 15m	Medicine	97112	CPT	8010357		Washington Regional Medical Center	outpatient	146	73	WellCare of North Carolina	North Carolina Medicaid/CHIP	51.33	24.15	109.5
97112-PHYS THER NRMSC RE-E 15m	97112-PHYS THER NRMSC RE-E 15m	Medicine	97112	CPT	8010357		Washington Regional Medical Center	outpatient	146	73	Healthy Blue / Blue Cross NC	North Carolina Medicaid	51.33	24.15	109.5
97112-PHYS THER NRMSC RE-E 15m	97112-PHYS THER NRMSC RE-E 15m	Medicine	97112	CPT	8010357		Washington Regional Medical Center	outpatient	146	73	Cigna	North Carolina PPO-PPA Direct	24.15	24.15	109.5
97112-PHYS THER NRMSC RE-E 15m	97112-PHYS THER NRMSC RE-E 15m	Medicine	97112	CPT	8010357		Washington Regional Medical Center	outpatient	146	73	Original Medicare	Traditional Medicare Fee-for-Service	68.62	24.15	109.5
97129 THER IVN COG FUN 1st 15m	97129 THER IVN COG FUN 1st 15m	Medicine	97129	CPT	10823084		Washington Regional Medical Center	outpatient	117	58.5	Self-Pay	Discounted Cash		20.99	87.75
97129 THER IVN COG FUN 1st 15m	97129 THER IVN COG FUN 1st 15m	Medicine	97129	CPT	10823084		Washington Regional Medical Center	outpatient	117	58.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	87.75	20.99	87.75
97129 THER IVN COG FUN 1st 15m	97129 THER IVN COG FUN 1st 15m	Medicine	97129	CPT	10823084		Washington Regional Medical Center	outpatient	117	58.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	51.48	20.99	87.75
97129 THER IVN COG FUN 1st 15m	97129 THER IVN COG FUN 1st 15m	Medicine	97129	CPT	10823084		Washington Regional Medical Center	outpatient	117	58.5	Humana	Medicare Advantage HMO/PPO/PFFS	54.99	20.99	87.75
97129 THER IVN COG FUN 1st 15m	97129 THER IVN COG FUN 1st 15m	Medicine	97129	CPT	10823084		Washington Regional Medical Center	outpatient	117	58.5	AmeriHealth Caritas North Carolina	NC Medicaid	41.14	20.99	87.75
97129 THER IVN COG FUN 1st 15m	97129 THER IVN COG FUN 1st 15m	Medicine	97129	CPT	10823084		Washington Regional Medical Center	outpatient	117	58.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	41.14	20.99	87.75
97129 THER IVN COG FUN 1st 15m	97129 THER IVN COG FUN 1st 15m	Medicine	97129	CPT	10823084		Washington Regional Medical Center	outpatient	117	58.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	41.14	20.99	87.75
97129 THER IVN COG FUN 1st 15m	97129 THER IVN COG FUN 1st 15m	Medicine	97129	CPT	10823084		Washington Regional Medical Center	outpatient	117	58.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	41.14	20.99	87.75
97129 THER IVN COG FUN 1st 15m	97129 THER IVN COG FUN 1st 15m	Medicine	97129	CPT	10823084		Washington Regional Medical Center	outpatient	117	58.5	Cigna	North Carolina PPO-PPA Direct	20.99	20.99	87.75
97129 THER IVN COG FUN 1st 15m	97129 THER IVN COG FUN 1st 15m	Medicine	97129	CPT	10823084		Washington Regional Medical Center	outpatient	117	58.5	Original Medicare	Traditional Medicare Fee-for-Service	54.99	20.99	87.75
97129 THER IVNTJ COGNITIVE FUN	97129 THER IVNTJ COGNITIVE FUN	Medicine	97129	CPT	10823085		Washington Regional Medical Center	outpatient	117	58.5	Self-Pay	Discounted Cash		20.99	87.75
97129 THER IVNTJ COGNITIVE FUN	97129 THER IVNTJ COGNITIVE FUN	Medicine	97129	CPT	10823085		Washington Regional Medical Center	outpatient	117	58.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	87.75	20.99	87.75
97129 THER IVNTJ COGNITIVE FUN	97129 THER IVNTJ COGNITIVE FUN	Medicine	97129	CPT	10823085		Washington Regional Medical Center	outpatient	117	58.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	51.48	20.99	87.75
97129 THER IVNTJ COGNITIVE FUN	97129 THER IVNTJ COGNITIVE FUN	Medicine	97129	CPT	10823085		Washington Regional Medical Center	outpatient	117	58.5	Humana	Medicare Advantage HMO/PPO/PFFS	54.99	20.99	87.75
97129 THER IVNTJ COGNITIVE FUN	97129 THER IVNTJ COGNITIVE FUN	Medicine	97129	CPT	10823085		Washington Regional Medical Center	outpatient	117	58.5	AmeriHealth Caritas North Carolina	NC Medicaid	41.14	20.99	87.75
97129 THER IVNTJ COGNITIVE FUN	97129 THER IVNTJ COGNITIVE FUN	Medicine	97129	CPT	10823085		Washington Regional Medical Center	outpatient	117	58.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	41.14	20.99	87.75
97129 THER IVNTJ COGNITIVE FUN	97129 THER IVNTJ COGNITIVE FUN	Medicine	97129	CPT	10823085		Washington Regional Medical Center	outpatient	117	58.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	41.14	20.99	87.75
97129 THER IVNTJ COGNITIVE FUN	97129 THER IVNTJ COGNITIVE FUN	Medicine	97129	CPT	10823085		Washington Regional Medical Center	outpatient	117	58.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	41.14	20.99	87.75
97129 THER IVNTJ COGNITIVE FUN	97129 THER IVNTJ COGNITIVE FUN	Medicine	97129	CPT	10823085		Washington Regional Medical Center	outpatient	117	58.5	Cigna	North Carolina PPO-PPA Direct	20.99	20.99	87.75
97129 THER IVNTJ COGNITIVE FUN	97129 THER IVNTJ COGNITIVE FUN	Medicine	97129	CPT	10823085		Washington Regional Medical Center	outpatient	117	58.5	Original Medicare	Traditional Medicare Fee-for-Service	54.99	20.99	87.75
97139 DRY NEEDLING PROC PT	97139 DRY NEEDLING PROC PT	Medicine	97139	CPT	10829022		Washington Regional Medical Center	outpatient	23	11.5	Self-Pay	Discounted Cash		8.09	17.25
97139 DRY NEEDLING PROC PT	97139 DRY NEEDLING PROC PT	Medicine	97139	CPT	10829022		Washington Regional Medical Center	outpatient	23	11.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	17.25	8.09	17.25
97139 DRY NEEDLING PROC PT	97139 DRY NEEDLING PROC PT	Medicine	97139	CPT	10829022		Washington Regional Medical Center	outpatient	23	11.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	10.12	8.09	17.25
97139 DRY NEEDLING PROC PT	97139 DRY NEEDLING PROC PT	Medicine	97139	CPT	10829022		Washington Regional Medical Center	outpatient	23	11.5	Humana	Medicare Advantage HMO/PPO/PFFS	10.81	8.09	17.25
97139 DRY NEEDLING PROC PT	97139 DRY NEEDLING PROC PT	Medicine	97139	CPT	10829022		Washington Regional Medical Center	outpatient	23	11.5	AmeriHealth Caritas North Carolina	NC Medicaid	8.09	8.09	17.25
97139 DRY NEEDLING PROC PT	97139 DRY NEEDLING PROC PT	Medicine	97139	CPT	10829022		Washington Regional Medical Center	outpatient	23	11.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	8.09	8.09	17.25
97139 DRY NEEDLING PROC PT	97139 DRY NEEDLING PROC PT	Medicine	97139	CPT	10829022		Washington Regional Medical Center	outpatient	23	11.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	8.09	8.09	17.25
97139 DRY NEEDLING PROC PT	97139 DRY NEEDLING PROC PT	Medicine	97139	CPT	10829022		Washington Regional Medical Center	outpatient	23	11.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	8.09	8.09	17.25
97139 DRY NEEDLING PROC PT	97139 DRY NEEDLING PROC PT	Medicine	97139	CPT	10829022		Washington Regional Medical Center	outpatient	23	11.5	Cigna	North Carolina PPO-PPA Direct	12.93	8.09	17.25
97139 DRY NEEDLING PROC PT	97139 DRY NEEDLING PROC PT	Medicine	97139	CPT	10829022		Washington Regional Medical Center	outpatient	23	11.5	Original Medicare	Traditional Medicare Fee-for-Service	10.81	8.09	17.25
97139 DRY NEEDLING PROCEDURE O	97139 DRY NEEDLING PROCEDURE O	Medicine	97139	CPT	10829023		Washington Regional Medical Center	outpatient	23	11.5	Self-Pay	Discounted Cash		8.09	17.25
97139 DRY NEEDLING PROCEDURE O	97139 DRY NEEDLING PROCEDURE O	Medicine	97139	CPT	10829023		Washington Regional Medical Center	outpatient	23	11.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	17.25	8.09	17.25
97139 DRY NEEDLING PROCEDURE O	97139 DRY NEEDLING PROCEDURE O	Medicine	97139	CPT	10829023		Washington Regional Medical Center	outpatient	23	11.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	10.12	8.09	17.25
97139 DRY NEEDLING PROCEDURE O	97139 DRY NEEDLING PROCEDURE O	Medicine	97139	CPT	10829023		Washington Regional Medical Center	outpatient	23	11.5	Humana	Medicare Advantage HMO/PPO/PFFS	10.81	8.09	17.25
97139 DRY NEEDLING PROCEDURE O	97139 DRY NEEDLING PROCEDURE O	Medicine	97139	CPT	10829023		Washington Regional Medical Center	outpatient	23	11.5	AmeriHealth Caritas North Carolina	NC Medicaid	8.09	8.09	17.25
97139 DRY NEEDLING PROCEDURE O	97139 DRY NEEDLING PROCEDURE O	Medicine	97139	CPT	10829023		Washington Regional Medical Center	outpatient	23	11.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	8.09	8.09	17.25
97139 DRY NEEDLING PROCEDURE O	97139 DRY NEEDLING PROCEDURE O	Medicine	97139	CPT	10829023		Washington Regional Medical Center	outpatient	23	11.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	8.09	8.09	17.25
97139 DRY NEEDLING PROCEDURE O	97139 DRY NEEDLING PROCEDURE O	Medicine	97139	CPT	10829023		Washington Regional Medical Center	outpatient	23	11.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	8.09	8.09	17.25
97139 DRY NEEDLING PROCEDURE O	97139 DRY NEEDLING PROCEDURE O	Medicine	97139	CPT	10829023		Washington Regional Medical Center	outpatient	23	11.5	Cigna	North Carolina PPO-PPA Direct	12.93	8.09	17.25
97139 DRY NEEDLING PROCEDURE O	97139 DRY NEEDLING PROCEDURE O	Medicine	97139	CPT	10829023		Washington Regional Medical Center	outpatient	23	11.5	Original Medicare	Traditional Medicare Fee-for-Service	10.81	8.09	17.25
97162 PHYS THER EVL MD CMP 30M	97162 PHYS THER EVL MD CMP 30M	Medicine	97162	CPT	8102093		Washington Regional Medical Center	outpatient	304	152	Self-Pay	Discounted Cash		69.92	228
97162 PHYS THER EVL MD CMP 30M	97162 PHYS THER EVL MD CMP 30M	Medicine	97162	CPT	8102093		Washington Regional Medical Center	outpatient	304	152	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	228	69.92	228
97162 PHYS THER EVL MD CMP 30M	97162 PHYS THER EVL MD CMP 30M	Medicine	97162	CPT	8102093		Washington Regional Medical Center	outpatient	304	152	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	133.76	69.92	228
97162 PHYS THER EVL MD CMP 30M	97162 PHYS THER EVL MD CMP 30M	Medicine	97162	CPT	8102093		Washington Regional Medical Center	outpatient	304	152	Humana	Medicare Advantage HMO/PPO/PFFS	142.88	69.92	228
97162 PHYS THER EVL MD CMP 30M	97162 PHYS THER EVL MD CMP 30M	Medicine	97162	CPT	8102093		Washington Regional Medical Center	outpatient	304	152	AmeriHealth Caritas North Carolina	NC Medicaid	106.89	69.92	228
97162 PHYS THER EVL MD CMP 30M	97162 PHYS THER EVL MD CMP 30M	Medicine	97162	CPT	8102093		Washington Regional Medical Center	outpatient	304	152	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	106.89	69.92	228
97162 PHYS THER EVL MD CMP 30M	97162 PHYS THER EVL MD CMP 30M	Medicine	97162	CPT	8102093		Washington Regional Medical Center	outpatient	304	152	WellCare of North Carolina	North Carolina Medicaid/CHIP	106.89	69.92	228
97162 PHYS THER EVL MD CMP 30M	97162 PHYS THER EVL MD CMP 30M	Medicine	97162	CPT	8102093		Washington Regional Medical Center	outpatient	304	152	Healthy Blue / Blue Cross NC	North Carolina Medicaid	106.89	69.92	228
97162 PHYS THER EVL MD CMP 30M	97162 PHYS THER EVL MD CMP 30M	Medicine	97162	CPT	8102093		Washington Regional Medical Center	outpatient	304	152	Cigna	North Carolina PPO-PPA Direct	69.92	69.92	228
97162 PHYS THER EVL MD CMP 30M	97162 PHYS THER EVL MD CMP 30M	Medicine	97162	CPT	8102093		Washington Regional Medical Center	outpatient	304	152	Original Medicare	Traditional Medicare Fee-for-Service	142.88	69.92	228
97530-OCC THER THER ACTIVITY 1	97530-OCC THER THER ACTIVITY 1	Medicine	97530	CPT	8010293		Washington Regional Medical Center	outpatient	140	70	Self-Pay	Discounted Cash		24.12	105
97530-OCC THER THER ACTIVITY 1	97530-OCC THER THER ACTIVITY 1	Medicine	97530	CPT	8010293		Washington Regional Medical Center	outpatient	140	70	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	105	24.12	105
97530-OCC THER THER ACTIVITY 1	97530-OCC THER THER ACTIVITY 1	Medicine	97530	CPT	8010293		Washington Regional Medical Center	outpatient	140	70	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	61.6	24.12	105
97530-OCC THER THER ACTIVITY 1	97530-OCC THER THER ACTIVITY 1	Medicine	97530	CPT	8010293		Washington Regional Medical Center	outpatient	140	70	Humana	Medicare Advantage HMO/PPO/PFFS	65.8	24.12	105
97530-OCC THER THER ACTIVITY 1	97530-OCC THER THER ACTIVITY 1	Medicine	97530	CPT	8010293		Washington Regional Medical Center	outpatient	140	70	AmeriHealth Caritas North Carolina	NC Medicaid	49.22	24.12	105
97530-OCC THER THER ACTIVITY 1	97530-OCC THER THER ACTIVITY 1	Medicine	97530	CPT	8010293		Washington Regional Medical Center	outpatient	140	70	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	49.22	24.12	105
97530-OCC THER THER ACTIVITY 1	97530-OCC THER THER ACTIVITY 1	Medicine	97530	CPT	8010293		Washington Regional Medical Center	outpatient	140	70	WellCare of North Carolina	North Carolina Medicaid/CHIP	49.22	24.12	105
97530-OCC THER THER ACTIVITY 1	97530-OCC THER THER ACTIVITY 1	Medicine	97530	CPT	8010293		Washington Regional Medical Center	outpatient	140	70	Healthy Blue / Blue Cross NC	North Carolina Medicaid	49.22	24.12	105
97530-OCC THER THER ACTIVITY 1	97530-OCC THER THER ACTIVITY 1	Medicine	97530	CPT	8010293		Washington Regional Medical Center	outpatient	140	70	Cigna	North Carolina PPO-PPA Direct	24.12	24.12	105
97530-OCC THER THER ACTIVITY 1	97530-OCC THER THER ACTIVITY 1	Medicine	97530	CPT	8010293		Washington Regional Medical Center	outpatient	140	70	Original Medicare	Traditional Medicare Fee-for-Service	65.8	24.12	105
97535-OCC THER SELF CARE HOME	97535-OCC THER SELF CARE HOME	Medicine	97535	CPT	8010272		Washington Regional Medical Center	outpatient	105	52.5	Self-Pay	Discounted Cash		24.53	78.75
97535-OCC THER SELF CARE HOME	97535-OCC THER SELF CARE HOME	Medicine	97535	CPT	8010272		Washington Regional Medical Center	outpatient	105	52.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	78.75	24.53	78.75
97535-OCC THER SELF CARE HOME	97535-OCC THER SELF CARE HOME	Medicine	97535	CPT	8010272		Washington Regional Medical Center	outpatient	105	52.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	46.2	24.53	78.75
97535-OCC THER SELF CARE HOME	97535-OCC THER SELF CARE HOME	Medicine	97535	CPT	8010272		Washington Regional Medical Center	outpatient	105	52.5	Humana	Medicare Advantage HMO/PPO/PFFS	49.35	24.53	78.75
97535-OCC THER SELF CARE HOME	97535-OCC THER SELF CARE HOME	Medicine	97535	CPT	8010272		Washington Regional Medical Center	outpatient	105	52.5	AmeriHealth Caritas North Carolina	NC Medicaid	36.92	24.53	78.75
97535-OCC THER SELF CARE HOME	97535-OCC THER SELF CARE HOME	Medicine	97535	CPT	8010272		Washington Regional Medical Center	outpatient	105	52.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	36.92	24.53	78.75
97535-OCC THER SELF CARE HOME	97535-OCC THER SELF CARE HOME	Medicine	97535	CPT	8010272		Washington Regional Medical Center	outpatient	105	52.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	36.92	24.53	78.75
97535-OCC THER SELF CARE HOME	97535-OCC THER SELF CARE HOME	Medicine	97535	CPT	8010272		Washington Regional Medical Center	outpatient	105	52.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	36.92	24.53	78.75
97535-OCC THER SELF CARE HOME	97535-OCC THER SELF CARE HOME	Medicine	97535	CPT	8010272		Washington Regional Medical Center	outpatient	105	52.5	Cigna	North Carolina PPO-PPA Direct	24.53	24.53	78.75
97535-OCC THER SELF CARE HOME	97535-OCC THER SELF CARE HOME	Medicine	97535	CPT	8010272		Washington Regional Medical Center	outpatient	105	52.5	Original Medicare	Traditional Medicare Fee-for-Service	49.35	24.53	78.75
97535-PHYS THER SELFCR HME 15M	97535-PHYS THER SELFCR HME 15M	Medicine	97535	CPT	8010378		Washington Regional Medical Center	outpatient	105	52.5	Self-Pay	Discounted Cash		24.53	78.75
97535-PHYS THER SELFCR HME 15M	97535-PHYS THER SELFCR HME 15M	Medicine	97535	CPT	8010378		Washington Regional Medical Center	outpatient	105	52.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	78.75	24.53	78.75
97535-PHYS THER SELFCR HME 15M	97535-PHYS THER SELFCR HME 15M	Medicine	97535	CPT	8010378		Washington Regional Medical Center	outpatient	105	52.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	46.2	24.53	78.75
97535-PHYS THER SELFCR HME 15M	97535-PHYS THER SELFCR HME 15M	Medicine	97535	CPT	8010378		Washington Regional Medical Center	outpatient	105	52.5	Humana	Medicare Advantage HMO/PPO/PFFS	49.35	24.53	78.75
97535-PHYS THER SELFCR HME 15M	97535-PHYS THER SELFCR HME 15M	Medicine	97535	CPT	8010378		Washington Regional Medical Center	outpatient	105	52.5	AmeriHealth Caritas North Carolina	NC Medicaid	36.92	24.53	78.75
97535-PHYS THER SELFCR HME 15M	97535-PHYS THER SELFCR HME 15M	Medicine	97535	CPT	8010378		Washington Regional Medical Center	outpatient	105	52.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	36.92	24.53	78.75
97535-PHYS THER SELFCR HME 15M	97535-PHYS THER SELFCR HME 15M	Medicine	97535	CPT	8010378		Washington Regional Medical Center	outpatient	105	52.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	36.92	24.53	78.75
97535-PHYS THER SELFCR HME 15M	97535-PHYS THER SELFCR HME 15M	Medicine	97535	CPT	8010378		Washington Regional Medical Center	outpatient	105	52.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	36.92	24.53	78.75
97535-PHYS THER SELFCR HME 15M	97535-PHYS THER SELFCR HME 15M	Medicine	97535	CPT	8010378		Washington Regional Medical Center	outpatient	105	52.5	Cigna	North Carolina PPO-PPA Direct	24.53	24.53	78.75
97535-PHYS THER SELFCR HME 15M	97535-PHYS THER SELFCR HME 15M	Medicine	97535	CPT	8010378		Washington Regional Medical Center	outpatient	105	52.5	Original Medicare	Traditional Medicare Fee-for-Service	49.35	24.53	78.75
97750 PHYS THER PHYSICL PRF15M	97750 PHYS THER PHYSICL PRF15M	Medicine	97750	CPT	8010367		Washington Regional Medical Center	outpatient	143	71.5	Self-Pay	Discounted Cash		24.44	107.25
97750 PHYS THER PHYSICL PRF15M	97750 PHYS THER PHYSICL PRF15M	Medicine	97750	CPT	8010367		Washington Regional Medical Center	outpatient	143	71.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	107.25	24.44	107.25
97750 PHYS THER PHYSICL PRF15M	97750 PHYS THER PHYSICL PRF15M	Medicine	97750	CPT	8010367		Washington Regional Medical Center	outpatient	143	71.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	62.92	24.44	107.25
97750 PHYS THER PHYSICL PRF15M	97750 PHYS THER PHYSICL PRF15M	Medicine	97750	CPT	8010367		Washington Regional Medical Center	outpatient	143	71.5	Humana	Medicare Advantage HMO/PPO/PFFS	67.21	24.44	107.25
97750 PHYS THER PHYSICL PRF15M	97750 PHYS THER PHYSICL PRF15M	Medicine	97750	CPT	8010367		Washington Regional Medical Center	outpatient	143	71.5	AmeriHealth Caritas North Carolina	NC Medicaid	50.28	24.44	107.25
97750 PHYS THER PHYSICL PRF15M	97750 PHYS THER PHYSICL PRF15M	Medicine	97750	CPT	8010367		Washington Regional Medical Center	outpatient	143	71.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	50.28	24.44	107.25
97750 PHYS THER PHYSICL PRF15M	97750 PHYS THER PHYSICL PRF15M	Medicine	97750	CPT	8010367		Washington Regional Medical Center	outpatient	143	71.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	50.28	24.44	107.25
97750 PHYS THER PHYSICL PRF15M	97750 PHYS THER PHYSICL PRF15M	Medicine	97750	CPT	8010367		Washington Regional Medical Center	outpatient	143	71.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	50.28	24.44	107.25
97750 PHYS THER PHYSICL PRF15M	97750 PHYS THER PHYSICL PRF15M	Medicine	97750	CPT	8010367		Washington Regional Medical Center	outpatient	143	71.5	Cigna	North Carolina PPO-PPA Direct	24.44	24.44	107.25
97750 PHYS THER PHYSICL PRF15M	97750 PHYS THER PHYSICL PRF15M	Medicine	97750	CPT	8010367		Washington Regional Medical Center	outpatient	143	71.5	Original Medicare	Traditional Medicare Fee-for-Service	67.21	24.44	107.25
97762-OCC THER ORTHOTIC RECHEC	97762-OCC THER ORTHOTIC RECHEC	Medicine	97762	CPT	8010254		Washington Regional Medical Center	outpatient	322	161	Self-Pay	Discounted Cash		113.22	241.5
97762-OCC THER ORTHOTIC RECHEC	97762-OCC THER ORTHOTIC RECHEC	Medicine	97762	CPT	8010254		Washington Regional Medical Center	outpatient	322	161	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	241.5	113.22	241.5
97762-OCC THER ORTHOTIC RECHEC	97762-OCC THER ORTHOTIC RECHEC	Medicine	97762	CPT	8010254		Washington Regional Medical Center	outpatient	322	161	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	141.68	113.22	241.5
97762-OCC THER ORTHOTIC RECHEC	97762-OCC THER ORTHOTIC RECHEC	Medicine	97762	CPT	8010254		Washington Regional Medical Center	outpatient	322	161	Humana	Medicare Advantage HMO/PPO/PFFS	151.34	113.22	241.5
97762-OCC THER ORTHOTIC RECHEC	97762-OCC THER ORTHOTIC RECHEC	Medicine	97762	CPT	8010254		Washington Regional Medical Center	outpatient	322	161	AmeriHealth Caritas North Carolina	NC Medicaid	113.22	113.22	241.5
97762-OCC THER ORTHOTIC RECHEC	97762-OCC THER ORTHOTIC RECHEC	Medicine	97762	CPT	8010254		Washington Regional Medical Center	outpatient	322	161	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	113.22	113.22	241.5
97762-OCC THER ORTHOTIC RECHEC	97762-OCC THER ORTHOTIC RECHEC	Medicine	97762	CPT	8010254		Washington Regional Medical Center	outpatient	322	161	WellCare of North Carolina	North Carolina Medicaid/CHIP	113.22	113.22	241.5
97762-OCC THER ORTHOTIC RECHEC	97762-OCC THER ORTHOTIC RECHEC	Medicine	97762	CPT	8010254		Washington Regional Medical Center	outpatient	322	161	Healthy Blue / Blue Cross NC	North Carolina Medicaid	113.22	113.22	241.5
97762-OCC THER ORTHOTIC RECHEC	97762-OCC THER ORTHOTIC RECHEC	Medicine	97762	CPT	8010254		Washington Regional Medical Center	outpatient	322	161	Original Medicare	Traditional Medicare Fee-for-Service	151.34	113.22	241.5
ADVANCED CARE 1ST 30 MIN	ADVANCED CARE 1ST 30 MIN	Medicine	99497	CPT	7500003		Washington Regional Medical Center	outpatient	302.48	151.24	Self-Pay	Discounted Cash		106.35	226.86
ADVANCED CARE 1ST 30 MIN	ADVANCED CARE 1ST 30 MIN	Medicine	99497	CPT	7500003		Washington Regional Medical Center	outpatient	302.48	151.24	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	226.86	106.35	226.86
ADVANCED CARE 1ST 30 MIN	ADVANCED CARE 1ST 30 MIN	Medicine	99497	CPT	7500003		Washington Regional Medical Center	outpatient	302.48	151.24	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	133.09	106.35	226.86
ADVANCED CARE 1ST 30 MIN	ADVANCED CARE 1ST 30 MIN	Medicine	99497	CPT	7500003		Washington Regional Medical Center	outpatient	302.48	151.24	Humana	Medicare Advantage HMO/PPO/PFFS	142.17	106.35	226.86
ADVANCED CARE 1ST 30 MIN	ADVANCED CARE 1ST 30 MIN	Medicine	99497	CPT	7500003		Washington Regional Medical Center	outpatient	302.48	151.24	AmeriHealth Caritas North Carolina	NC Medicaid	106.35	106.35	226.86
ADVANCED CARE 1ST 30 MIN	ADVANCED CARE 1ST 30 MIN	Medicine	99497	CPT	7500003		Washington Regional Medical Center	outpatient	302.48	151.24	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	106.35	106.35	226.86
ADVANCED CARE 1ST 30 MIN	ADVANCED CARE 1ST 30 MIN	Medicine	99497	CPT	7500003		Washington Regional Medical Center	outpatient	302.48	151.24	WellCare of North Carolina	North Carolina Medicaid/CHIP	106.35	106.35	226.86
ADVANCED CARE 1ST 30 MIN	ADVANCED CARE 1ST 30 MIN	Medicine	99497	CPT	7500003		Washington Regional Medical Center	outpatient	302.48	151.24	Healthy Blue / Blue Cross NC	North Carolina Medicaid	106.35	106.35	226.86
ADVANCED CARE 1ST 30 MIN	ADVANCED CARE 1ST 30 MIN	Medicine	99497	CPT	7500003		Washington Regional Medical Center	outpatient	302.48	151.24	Original Medicare	Traditional Medicare Fee-for-Service	142.17	106.35	226.86
ANTIBIOTIC ADMINISTRATION	ANTIBIOTIC ADMINISTRATION	Medicine	96372	CPT	6001025		Washington Regional Medical Center	outpatient	189.96	94.98	Self-Pay	Discounted Cash		22.78	142.47
ANTIBIOTIC ADMINISTRATION	ANTIBIOTIC ADMINISTRATION	Medicine	96372	CPT	6001025		Washington Regional Medical Center	outpatient	189.96	94.98	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	142.47	22.78	142.47
ANTIBIOTIC ADMINISTRATION	ANTIBIOTIC ADMINISTRATION	Medicine	96372	CPT	6001025		Washington Regional Medical Center	outpatient	189.96	94.98	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	83.58	22.78	142.47
ANTIBIOTIC ADMINISTRATION	ANTIBIOTIC ADMINISTRATION	Medicine	96372	CPT	6001025		Washington Regional Medical Center	outpatient	189.96	94.98	Humana	Medicare Advantage HMO/PPO/PFFS	89.28	22.78	142.47
ANTIBIOTIC ADMINISTRATION	ANTIBIOTIC ADMINISTRATION	Medicine	96372	CPT	6001025		Washington Regional Medical Center	outpatient	189.96	94.98	AmeriHealth Caritas North Carolina	NC Medicaid	66.79	22.78	142.47
ANTIBIOTIC ADMINISTRATION	ANTIBIOTIC ADMINISTRATION	Medicine	96372	CPT	6001025		Washington Regional Medical Center	outpatient	189.96	94.98	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	66.79	22.78	142.47
ANTIBIOTIC ADMINISTRATION	ANTIBIOTIC ADMINISTRATION	Medicine	96372	CPT	6001025		Washington Regional Medical Center	outpatient	189.96	94.98	WellCare of North Carolina	North Carolina Medicaid/CHIP	66.79	22.78	142.47
ANTIBIOTIC ADMINISTRATION	ANTIBIOTIC ADMINISTRATION	Medicine	96372	CPT	6001025		Washington Regional Medical Center	outpatient	189.96	94.98	Healthy Blue / Blue Cross NC	North Carolina Medicaid	66.79	22.78	142.47
ANTIBIOTIC ADMINISTRATION	ANTIBIOTIC ADMINISTRATION	Medicine	96372	CPT	6001025		Washington Regional Medical Center	outpatient	189.96	94.98	Cigna	North Carolina PPO-PPA Direct	22.78	22.78	142.47
ANTIBIOTIC ADMINISTRATION	ANTIBIOTIC ADMINISTRATION	Medicine	96372	CPT	6001025		Washington Regional Medical Center	outpatient	189.96	94.98	Original Medicare	Traditional Medicare Fee-for-Service	89.28	22.78	142.47
Apply fluor varn pri tth 99188	Apply fluor varn pri tth 99188	Medicine	99188	CPT	7810119		Washington Regional Medical Center	outpatient	53	26.5	Self-Pay	Discounted Cash		18.63	39.75
Apply fluor varn pri tth 99188	Apply fluor varn pri tth 99188	Medicine	99188	CPT	7810119		Washington Regional Medical Center	outpatient	53	26.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	39.75	18.63	39.75
Apply fluor varn pri tth 99188	Apply fluor varn pri tth 99188	Medicine	99188	CPT	7810119		Washington Regional Medical Center	outpatient	53	26.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	23.32	18.63	39.75
Apply fluor varn pri tth 99188	Apply fluor varn pri tth 99188	Medicine	99188	CPT	7810119		Washington Regional Medical Center	outpatient	53	26.5	Humana	Medicare Advantage HMO/PPO/PFFS	24.91	18.63	39.75
Apply fluor varn pri tth 99188	Apply fluor varn pri tth 99188	Medicine	99188	CPT	7810119		Washington Regional Medical Center	outpatient	53	26.5	AmeriHealth Caritas North Carolina	NC Medicaid	18.63	18.63	39.75
Apply fluor varn pri tth 99188	Apply fluor varn pri tth 99188	Medicine	99188	CPT	7810119		Washington Regional Medical Center	outpatient	53	26.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	18.63	18.63	39.75
Apply fluor varn pri tth 99188	Apply fluor varn pri tth 99188	Medicine	99188	CPT	7810119		Washington Regional Medical Center	outpatient	53	26.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	18.63	18.63	39.75
Apply fluor varn pri tth 99188	Apply fluor varn pri tth 99188	Medicine	99188	CPT	7810119		Washington Regional Medical Center	outpatient	53	26.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	18.63	18.63	39.75
Apply fluor varn pri tth 99188	Apply fluor varn pri tth 99188	Medicine	99188	CPT	7810119		Washington Regional Medical Center	outpatient	53	26.5	Original Medicare	Traditional Medicare Fee-for-Service	24.91	18.63	39.75
ATH TRN EVAL MOD COMP 30 MINS	ATH TRN EVAL MOD COMP 30 MINS	Medicine	97170	CPT	4201064		Washington Regional Medical Center	outpatient	260	130	Self-Pay	Discounted Cash		46.52	195
ATH TRN EVAL MOD COMP 30 MINS	ATH TRN EVAL MOD COMP 30 MINS	Medicine	97170	CPT	4201064		Washington Regional Medical Center	outpatient	260	130	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	195	46.52	195
ATH TRN EVAL MOD COMP 30 MINS	ATH TRN EVAL MOD COMP 30 MINS	Medicine	97170	CPT	4201064		Washington Regional Medical Center	outpatient	260	130	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	114.4	46.52	195
ATH TRN EVAL MOD COMP 30 MINS	ATH TRN EVAL MOD COMP 30 MINS	Medicine	97170	CPT	4201064		Washington Regional Medical Center	outpatient	260	130	Humana	Medicare Advantage HMO/PPO/PFFS	122.2	46.52	195
ATH TRN EVAL MOD COMP 30 MINS	ATH TRN EVAL MOD COMP 30 MINS	Medicine	97170	CPT	4201064		Washington Regional Medical Center	outpatient	260	130	AmeriHealth Caritas North Carolina	NC Medicaid	91.42	46.52	195
ATH TRN EVAL MOD COMP 30 MINS	ATH TRN EVAL MOD COMP 30 MINS	Medicine	97170	CPT	4201064		Washington Regional Medical Center	outpatient	260	130	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	91.42	46.52	195
ATH TRN EVAL MOD COMP 30 MINS	ATH TRN EVAL MOD COMP 30 MINS	Medicine	97170	CPT	4201064		Washington Regional Medical Center	outpatient	260	130	WellCare of North Carolina	North Carolina Medicaid/CHIP	91.42	46.52	195
ATH TRN EVAL MOD COMP 30 MINS	ATH TRN EVAL MOD COMP 30 MINS	Medicine	97170	CPT	4201064		Washington Regional Medical Center	outpatient	260	130	Healthy Blue / Blue Cross NC	North Carolina Medicaid	91.42	46.52	195
ATH TRN EVAL MOD COMP 30 MINS	ATH TRN EVAL MOD COMP 30 MINS	Medicine	97170	CPT	4201064		Washington Regional Medical Center	outpatient	260	130	Cigna	North Carolina PPO-PPA Direct	46.52	46.52	195
ATH TRN EVAL MOD COMP 30 MINS	ATH TRN EVAL MOD COMP 30 MINS	Medicine	97170	CPT	4201064		Washington Regional Medical Center	outpatient	260	130	Original Medicare	Traditional Medicare Fee-for-Service	122.2	46.52	195
BEHAV CHNG SMOKING > 10 MIN	BEHAV CHNG SMOKING > 10 MIN	Medicine	99407	CPT	2389523		Washington Regional Medical Center	outpatient	107.36	53.68	Self-Pay	Discounted Cash		24.39	80.52
BEHAV CHNG SMOKING > 10 MIN	BEHAV CHNG SMOKING > 10 MIN	Medicine	99407	CPT	2389523		Washington Regional Medical Center	outpatient	107.36	53.68	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	80.52	24.39	80.52
BEHAV CHNG SMOKING > 10 MIN	BEHAV CHNG SMOKING > 10 MIN	Medicine	99407	CPT	2389523		Washington Regional Medical Center	outpatient	107.36	53.68	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	47.24	24.39	80.52
BEHAV CHNG SMOKING > 10 MIN	BEHAV CHNG SMOKING > 10 MIN	Medicine	99407	CPT	2389523		Washington Regional Medical Center	outpatient	107.36	53.68	Humana	Medicare Advantage HMO/PPO/PFFS	50.46	24.39	80.52
BEHAV CHNG SMOKING > 10 MIN	BEHAV CHNG SMOKING > 10 MIN	Medicine	99407	CPT	2389523		Washington Regional Medical Center	outpatient	107.36	53.68	AmeriHealth Caritas North Carolina	NC Medicaid	37.75	24.39	80.52
BEHAV CHNG SMOKING > 10 MIN	BEHAV CHNG SMOKING > 10 MIN	Medicine	99407	CPT	2389523		Washington Regional Medical Center	outpatient	107.36	53.68	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	37.75	24.39	80.52
BEHAV CHNG SMOKING > 10 MIN	BEHAV CHNG SMOKING > 10 MIN	Medicine	99407	CPT	2389523		Washington Regional Medical Center	outpatient	107.36	53.68	WellCare of North Carolina	North Carolina Medicaid/CHIP	37.75	24.39	80.52
BEHAV CHNG SMOKING > 10 MIN	BEHAV CHNG SMOKING > 10 MIN	Medicine	99407	CPT	2389523		Washington Regional Medical Center	outpatient	107.36	53.68	Healthy Blue / Blue Cross NC	North Carolina Medicaid	37.75	24.39	80.52
BEHAV CHNG SMOKING > 10 MIN	BEHAV CHNG SMOKING > 10 MIN	Medicine	99407	CPT	2389523		Washington Regional Medical Center	outpatient	107.36	53.68	Cigna	North Carolina PPO-PPA Direct	24.39	24.39	80.52
BEHAV CHNG SMOKING > 10 MIN	BEHAV CHNG SMOKING > 10 MIN	Medicine	99407	CPT	2389523		Washington Regional Medical Center	outpatient	107.36	53.68	Original Medicare	Traditional Medicare Fee-for-Service	50.46	24.39	80.52
BRONCHODILATOR METHAC PRE/POST	BRONCHODILATOR METHAC PRE/POST	Medicine	94070	CPT	4001133		Washington Regional Medical Center	outpatient	1081.16	540.58	Self-Pay	Discounted Cash		27.35	810.87
BRONCHODILATOR METHAC PRE/POST	BRONCHODILATOR METHAC PRE/POST	Medicine	94070	CPT	4001133		Washington Regional Medical Center	outpatient	1081.16	540.58	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	810.87	27.35	810.87
BRONCHODILATOR METHAC PRE/POST	BRONCHODILATOR METHAC PRE/POST	Medicine	94070	CPT	4001133		Washington Regional Medical Center	outpatient	1081.16	540.58	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	475.71	27.35	810.87
BRONCHODILATOR METHAC PRE/POST	BRONCHODILATOR METHAC PRE/POST	Medicine	94070	CPT	4001133		Washington Regional Medical Center	outpatient	1081.16	540.58	Humana	Medicare Advantage HMO/PPO/PFFS	508.15	27.35	810.87
BRONCHODILATOR METHAC PRE/POST	BRONCHODILATOR METHAC PRE/POST	Medicine	94070	CPT	4001133		Washington Regional Medical Center	outpatient	1081.16	540.58	AmeriHealth Caritas North Carolina	NC Medicaid	380.14	27.35	810.87
BRONCHODILATOR METHAC PRE/POST	BRONCHODILATOR METHAC PRE/POST	Medicine	94070	CPT	4001133		Washington Regional Medical Center	outpatient	1081.16	540.58	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	380.14	27.35	810.87
BRONCHODILATOR METHAC PRE/POST	BRONCHODILATOR METHAC PRE/POST	Medicine	94070	CPT	4001133		Washington Regional Medical Center	outpatient	1081.16	540.58	WellCare of North Carolina	North Carolina Medicaid/CHIP	380.14	27.35	810.87
BRONCHODILATOR METHAC PRE/POST	BRONCHODILATOR METHAC PRE/POST	Medicine	94070	CPT	4001133		Washington Regional Medical Center	outpatient	1081.16	540.58	Healthy Blue / Blue Cross NC	North Carolina Medicaid	380.14	27.35	810.87
BRONCHODILATOR METHAC PRE/POST	BRONCHODILATOR METHAC PRE/POST	Medicine	94070	CPT	4001133		Washington Regional Medical Center	outpatient	1081.16	540.58	Cigna	North Carolina PPO-PPA Direct	27.35	27.35	810.87
BRONCHODILATOR METHAC PRE/POST	BRONCHODILATOR METHAC PRE/POST	Medicine	94070	CPT	4001133		Washington Regional Medical Center	outpatient	1081.16	540.58	Original Medicare	Traditional Medicare Fee-for-Service	508.15	27.35	810.87
CHEST PT/PDP SUB	CHEST PT/PDP SUB	Medicine	94668	CPT	4001008		Washington Regional Medical Center	outpatient	322	161	Self-Pay	Discounted Cash		17.89	241.5
CHEST PT/PDP SUB	CHEST PT/PDP SUB	Medicine	94668	CPT	4001008		Washington Regional Medical Center	outpatient	322	161	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	241.5	17.89	241.5
CHEST PT/PDP SUB	CHEST PT/PDP SUB	Medicine	94668	CPT	4001008		Washington Regional Medical Center	outpatient	322	161	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	141.68	17.89	241.5
CHEST PT/PDP SUB	CHEST PT/PDP SUB	Medicine	94668	CPT	4001008		Washington Regional Medical Center	outpatient	322	161	Humana	Medicare Advantage HMO/PPO/PFFS	151.34	17.89	241.5
CHEST PT/PDP SUB	CHEST PT/PDP SUB	Medicine	94668	CPT	4001008		Washington Regional Medical Center	outpatient	322	161	AmeriHealth Caritas North Carolina	NC Medicaid	113.22	17.89	241.5
CHEST PT/PDP SUB	CHEST PT/PDP SUB	Medicine	94668	CPT	4001008		Washington Regional Medical Center	outpatient	322	161	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	113.22	17.89	241.5
CHEST PT/PDP SUB	CHEST PT/PDP SUB	Medicine	94668	CPT	4001008		Washington Regional Medical Center	outpatient	322	161	WellCare of North Carolina	North Carolina Medicaid/CHIP	113.22	17.89	241.5
CHEST PT/PDP SUB	CHEST PT/PDP SUB	Medicine	94668	CPT	4001008		Washington Regional Medical Center	outpatient	322	161	Healthy Blue / Blue Cross NC	North Carolina Medicaid	113.22	17.89	241.5
CHEST PT/PDP SUB	CHEST PT/PDP SUB	Medicine	94668	CPT	4001008		Washington Regional Medical Center	outpatient	322	161	Cigna	North Carolina PPO-PPA Direct	17.89	17.89	241.5
CHEST PT/PDP SUB	CHEST PT/PDP SUB	Medicine	94668	CPT	4001008		Washington Regional Medical Center	outpatient	322	161	Original Medicare	Traditional Medicare Fee-for-Service	151.34	17.89	241.5
CPAP/BIPAP-INITIAL/MGMT	CPAP/BIPAP-INITIAL/MGMT	Medicine	94660	CPT	4001009		Washington Regional Medical Center	outpatient	277	138.5	Self-Pay	Discounted Cash		41.62	207.75
CPAP/BIPAP-INITIAL/MGMT	CPAP/BIPAP-INITIAL/MGMT	Medicine	94660	CPT	4001009		Washington Regional Medical Center	outpatient	277	138.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	207.75	41.62	207.75
CPAP/BIPAP-INITIAL/MGMT	CPAP/BIPAP-INITIAL/MGMT	Medicine	94660	CPT	4001009		Washington Regional Medical Center	outpatient	277	138.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	121.88	41.62	207.75
CPAP/BIPAP-INITIAL/MGMT	CPAP/BIPAP-INITIAL/MGMT	Medicine	94660	CPT	4001009		Washington Regional Medical Center	outpatient	277	138.5	Humana	Medicare Advantage HMO/PPO/PFFS	130.19	41.62	207.75
CPAP/BIPAP-INITIAL/MGMT	CPAP/BIPAP-INITIAL/MGMT	Medicine	94660	CPT	4001009		Washington Regional Medical Center	outpatient	277	138.5	AmeriHealth Caritas North Carolina	NC Medicaid	97.39	41.62	207.75
CPAP/BIPAP-INITIAL/MGMT	CPAP/BIPAP-INITIAL/MGMT	Medicine	94660	CPT	4001009		Washington Regional Medical Center	outpatient	277	138.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	97.39	41.62	207.75
CPAP/BIPAP-INITIAL/MGMT	CPAP/BIPAP-INITIAL/MGMT	Medicine	94660	CPT	4001009		Washington Regional Medical Center	outpatient	277	138.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	97.39	41.62	207.75
CPAP/BIPAP-INITIAL/MGMT	CPAP/BIPAP-INITIAL/MGMT	Medicine	94660	CPT	4001009		Washington Regional Medical Center	outpatient	277	138.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	97.39	41.62	207.75
CPAP/BIPAP-INITIAL/MGMT	CPAP/BIPAP-INITIAL/MGMT	Medicine	94660	CPT	4001009		Washington Regional Medical Center	outpatient	277	138.5	Cigna	North Carolina PPO-PPA Direct	41.62	41.62	207.75
CPAP/BIPAP-INITIAL/MGMT	CPAP/BIPAP-INITIAL/MGMT	Medicine	94660	CPT	4001009		Washington Regional Medical Center	outpatient	277	138.5	Original Medicare	Traditional Medicare Fee-for-Service	130.19	41.62	207.75
Debrd Selctv EaAd 20sqcm 97598	Debrd Selctv EaAd 20sqcm 97598	Medicine	97598	CPT	2389140		Washington Regional Medical Center	outpatient	297	148.5	Self-Pay	Discounted Cash		50.34	222.75
Debrd Selctv EaAd 20sqcm 97598	Debrd Selctv EaAd 20sqcm 97598	Medicine	97598	CPT	2389140		Washington Regional Medical Center	outpatient	297	148.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	222.75	50.34	222.75
Debrd Selctv EaAd 20sqcm 97598	Debrd Selctv EaAd 20sqcm 97598	Medicine	97598	CPT	2389140		Washington Regional Medical Center	outpatient	297	148.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	130.68	50.34	222.75
Debrd Selctv EaAd 20sqcm 97598	Debrd Selctv EaAd 20sqcm 97598	Medicine	97598	CPT	2389140		Washington Regional Medical Center	outpatient	297	148.5	Humana	Medicare Advantage HMO/PPO/PFFS	139.59	50.34	222.75
Debrd Selctv EaAd 20sqcm 97598	Debrd Selctv EaAd 20sqcm 97598	Medicine	97598	CPT	2389140		Washington Regional Medical Center	outpatient	297	148.5	AmeriHealth Caritas North Carolina	NC Medicaid	104.43	50.34	222.75
Debrd Selctv EaAd 20sqcm 97598	Debrd Selctv EaAd 20sqcm 97598	Medicine	97598	CPT	2389140		Washington Regional Medical Center	outpatient	297	148.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	104.43	50.34	222.75
Debrd Selctv EaAd 20sqcm 97598	Debrd Selctv EaAd 20sqcm 97598	Medicine	97598	CPT	2389140		Washington Regional Medical Center	outpatient	297	148.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	104.43	50.34	222.75
Debrd Selctv EaAd 20sqcm 97598	Debrd Selctv EaAd 20sqcm 97598	Medicine	97598	CPT	2389140		Washington Regional Medical Center	outpatient	297	148.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	104.43	50.34	222.75
Debrd Selctv EaAd 20sqcm 97598	Debrd Selctv EaAd 20sqcm 97598	Medicine	97598	CPT	2389140		Washington Regional Medical Center	outpatient	297	148.5	Cigna	North Carolina PPO-PPA Direct	50.34	50.34	222.75
Debrd Selctv EaAd 20sqcm 97598	Debrd Selctv EaAd 20sqcm 97598	Medicine	97598	CPT	2389140		Washington Regional Medical Center	outpatient	297	148.5	Original Medicare	Traditional Medicare Fee-for-Service	139.59	50.34	222.75
Develop Scrn w/I&R 96110	Develop Scrn w/I&R 96110	Medicine	96110	CPT	2389039		Washington Regional Medical Center	outpatient	137	68.5	Self-Pay	Discounted Cash		11.74	102.75
Develop Scrn w/I&R 96110	Develop Scrn w/I&R 96110	Medicine	96110	CPT	2389039		Washington Regional Medical Center	outpatient	137	68.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	102.75	11.74	102.75
Develop Scrn w/I&R 96110	Develop Scrn w/I&R 96110	Medicine	96110	CPT	2389039		Washington Regional Medical Center	outpatient	137	68.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	60.28	11.74	102.75
Develop Scrn w/I&R 96110	Develop Scrn w/I&R 96110	Medicine	96110	CPT	2389039		Washington Regional Medical Center	outpatient	137	68.5	Humana	Medicare Advantage HMO/PPO/PFFS	64.39	11.74	102.75
Develop Scrn w/I&R 96110	Develop Scrn w/I&R 96110	Medicine	96110	CPT	2389039		Washington Regional Medical Center	outpatient	137	68.5	AmeriHealth Caritas North Carolina	NC Medicaid	48.17	11.74	102.75
Develop Scrn w/I&R 96110	Develop Scrn w/I&R 96110	Medicine	96110	CPT	2389039		Washington Regional Medical Center	outpatient	137	68.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	48.17	11.74	102.75
Develop Scrn w/I&R 96110	Develop Scrn w/I&R 96110	Medicine	96110	CPT	2389039		Washington Regional Medical Center	outpatient	137	68.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	48.17	11.74	102.75
Develop Scrn w/I&R 96110	Develop Scrn w/I&R 96110	Medicine	96110	CPT	2389039		Washington Regional Medical Center	outpatient	137	68.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	48.17	11.74	102.75
Develop Scrn w/I&R 96110	Develop Scrn w/I&R 96110	Medicine	96110	CPT	2389039		Washington Regional Medical Center	outpatient	137	68.5	Cigna	North Carolina PPO-PPA Direct	11.74	11.74	102.75
Develop Scrn w/I&R 96110	Develop Scrn w/I&R 96110	Medicine	96110	CPT	2389039		Washington Regional Medical Center	outpatient	137	68.5	Original Medicare	Traditional Medicare Fee-for-Service	64.39	11.74	102.75
DUPLEX SCAN OF HEMODI	DUPLEX SCAN OF HEMODI	Medicine	93990	CPT	2101116		Washington Regional Medical Center	outpatient	6676.14	3338.07	Self-Pay	Discounted Cash		156.52	5007.11
DUPLEX SCAN OF HEMODI	DUPLEX SCAN OF HEMODI	Medicine	93990	CPT	2101116		Washington Regional Medical Center	outpatient	6676.14	3338.07	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	5007.11	156.52	5007.11
DUPLEX SCAN OF HEMODI	DUPLEX SCAN OF HEMODI	Medicine	93990	CPT	2101116		Washington Regional Medical Center	outpatient	6676.14	3338.07	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	2937.5	156.52	5007.11
DUPLEX SCAN OF HEMODI	DUPLEX SCAN OF HEMODI	Medicine	93990	CPT	2101116		Washington Regional Medical Center	outpatient	6676.14	3338.07	Humana	Medicare Advantage HMO/PPO/PFFS	3137.79	156.52	5007.11
DUPLEX SCAN OF HEMODI	DUPLEX SCAN OF HEMODI	Medicine	93990	CPT	2101116		Washington Regional Medical Center	outpatient	6676.14	3338.07	AmeriHealth Caritas North Carolina	NC Medicaid	2347.33	156.52	5007.11
DUPLEX SCAN OF HEMODI	DUPLEX SCAN OF HEMODI	Medicine	93990	CPT	2101116		Washington Regional Medical Center	outpatient	6676.14	3338.07	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	2347.33	156.52	5007.11
DUPLEX SCAN OF HEMODI	DUPLEX SCAN OF HEMODI	Medicine	93990	CPT	2101116		Washington Regional Medical Center	outpatient	6676.14	3338.07	WellCare of North Carolina	North Carolina Medicaid/CHIP	2347.33	156.52	5007.11
DUPLEX SCAN OF HEMODI	DUPLEX SCAN OF HEMODI	Medicine	93990	CPT	2101116		Washington Regional Medical Center	outpatient	6676.14	3338.07	Healthy Blue / Blue Cross NC	North Carolina Medicaid	2347.33	156.52	5007.11
DUPLEX SCAN OF HEMODI	DUPLEX SCAN OF HEMODI	Medicine	93990	CPT	2101116		Washington Regional Medical Center	outpatient	6676.14	3338.07	Cigna	North Carolina PPO-PPA Direct	156.52	156.52	5007.11
DUPLEX SCAN OF HEMODI	DUPLEX SCAN OF HEMODI	Medicine	93990	CPT	2101116		Washington Regional Medical Center	outpatient	6676.14	3338.07	Original Medicare	Traditional Medicare Fee-for-Service	3137.79	156.52	5007.11
ED Psych DxEval w/MedSrv 90792	ED Psych DxEval w/MedSrv 90792	Medicine	90792	CPT	10832926		Washington Regional Medical Center	outpatient	320	160	Self-Pay	Discounted Cash		112.51	240
ED Psych DxEval w/MedSrv 90792	ED Psych DxEval w/MedSrv 90792	Medicine	90792	CPT	10832926		Washington Regional Medical Center	outpatient	320	160	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	240	112.51	240
ED Psych DxEval w/MedSrv 90792	ED Psych DxEval w/MedSrv 90792	Medicine	90792	CPT	10832926		Washington Regional Medical Center	outpatient	320	160	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	140.8	112.51	240
ED Psych DxEval w/MedSrv 90792	ED Psych DxEval w/MedSrv 90792	Medicine	90792	CPT	10832926		Washington Regional Medical Center	outpatient	320	160	Humana	Medicare Advantage HMO/PPO/PFFS	150.4	112.51	240
ED Psych DxEval w/MedSrv 90792	ED Psych DxEval w/MedSrv 90792	Medicine	90792	CPT	10832926		Washington Regional Medical Center	outpatient	320	160	AmeriHealth Caritas North Carolina	NC Medicaid	112.51	112.51	240
ED Psych DxEval w/MedSrv 90792	ED Psych DxEval w/MedSrv 90792	Medicine	90792	CPT	10832926		Washington Regional Medical Center	outpatient	320	160	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	112.51	112.51	240
ED Psych DxEval w/MedSrv 90792	ED Psych DxEval w/MedSrv 90792	Medicine	90792	CPT	10832926		Washington Regional Medical Center	outpatient	320	160	WellCare of North Carolina	North Carolina Medicaid/CHIP	112.51	112.51	240
ED Psych DxEval w/MedSrv 90792	ED Psych DxEval w/MedSrv 90792	Medicine	90792	CPT	10832926		Washington Regional Medical Center	outpatient	320	160	Healthy Blue / Blue Cross NC	North Carolina Medicaid	112.51	112.51	240
ED Psych DxEval w/MedSrv 90792	ED Psych DxEval w/MedSrv 90792	Medicine	90792	CPT	10832926		Washington Regional Medical Center	outpatient	320	160	Cigna	North Carolina PPO-PPA Direct	144.84	112.51	240
ED Psych DxEval w/MedSrv 90792	ED Psych DxEval w/MedSrv 90792	Medicine	90792	CPT	10832926		Washington Regional Medical Center	outpatient	320	160	Original Medicare	Traditional Medicare Fee-for-Service	150.4	112.51	240
ED Visit Level 1 – Pro	ED Visit Level 1 – Pro	Medicine	99281	CPT	7500010		Washington Regional Medical Center	outpatient	86.24	43.12	Self-Pay	Discounted Cash		17.76	64.68
ED Visit Level 1 – Pro	ED Visit Level 1 – Pro	Medicine	99281	CPT	7500010		Washington Regional Medical Center	outpatient	86.24	43.12	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	64.68	17.76	64.68
ED Visit Level 1 – Pro	ED Visit Level 1 – Pro	Medicine	99281	CPT	7500010		Washington Regional Medical Center	outpatient	86.24	43.12	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	37.95	17.76	64.68
ED Visit Level 1 – Pro	ED Visit Level 1 – Pro	Medicine	99281	CPT	7500010		Washington Regional Medical Center	outpatient	86.24	43.12	Humana	Medicare Advantage HMO/PPO/PFFS	40.53	17.76	64.68
ED Visit Level 1 – Pro	ED Visit Level 1 – Pro	Medicine	99281	CPT	7500010		Washington Regional Medical Center	outpatient	86.24	43.12	AmeriHealth Caritas North Carolina	NC Medicaid	30.32	17.76	64.68
ED Visit Level 1 – Pro	ED Visit Level 1 – Pro	Medicine	99281	CPT	7500010		Washington Regional Medical Center	outpatient	86.24	43.12	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	30.32	17.76	64.68
ED Visit Level 1 – Pro	ED Visit Level 1 – Pro	Medicine	99281	CPT	7500010		Washington Regional Medical Center	outpatient	86.24	43.12	WellCare of North Carolina	North Carolina Medicaid/CHIP	30.32	17.76	64.68
ED Visit Level 1 – Pro	ED Visit Level 1 – Pro	Medicine	99281	CPT	7500010		Washington Regional Medical Center	outpatient	86.24	43.12	Healthy Blue / Blue Cross NC	North Carolina Medicaid	30.32	17.76	64.68
ED Visit Level 1 – Pro	ED Visit Level 1 – Pro	Medicine	99281	CPT	7500010		Washington Regional Medical Center	outpatient	86.24	43.12	Cigna	North Carolina PPO-PPA Direct	17.76	17.76	64.68
ED Visit Level 1 – Pro	ED Visit Level 1 – Pro	Medicine	99281	CPT	7500010		Washington Regional Medical Center	outpatient	86.24	43.12	Original Medicare	Traditional Medicare Fee-for-Service	40.53	17.76	64.68
ED Visit Level 4 – Pro	ED Visit Level 4 – Pro	Medicine	99284	CPT	7500013		Washington Regional Medical Center	outpatient	480.4	240.2	Self-Pay	Discounted Cash		103.15	360.3
ED Visit Level 4 – Pro	ED Visit Level 4 – Pro	Medicine	99284	CPT	7500013		Washington Regional Medical Center	outpatient	480.4	240.2	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	360.3	103.15	360.3
ED Visit Level 4 – Pro	ED Visit Level 4 – Pro	Medicine	99284	CPT	7500013		Washington Regional Medical Center	outpatient	480.4	240.2	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	211.38	103.15	360.3
ED Visit Level 4 – Pro	ED Visit Level 4 – Pro	Medicine	99284	CPT	7500013		Washington Regional Medical Center	outpatient	480.4	240.2	Humana	Medicare Advantage HMO/PPO/PFFS	225.79	103.15	360.3
ED Visit Level 4 – Pro	ED Visit Level 4 – Pro	Medicine	99284	CPT	7500013		Washington Regional Medical Center	outpatient	480.4	240.2	AmeriHealth Caritas North Carolina	NC Medicaid	168.91	103.15	360.3
ED Visit Level 4 – Pro	ED Visit Level 4 – Pro	Medicine	99284	CPT	7500013		Washington Regional Medical Center	outpatient	480.4	240.2	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	168.91	103.15	360.3
ED Visit Level 4 – Pro	ED Visit Level 4 – Pro	Medicine	99284	CPT	7500013		Washington Regional Medical Center	outpatient	480.4	240.2	WellCare of North Carolina	North Carolina Medicaid/CHIP	168.91	103.15	360.3
ED Visit Level 4 – Pro	ED Visit Level 4 – Pro	Medicine	99284	CPT	7500013		Washington Regional Medical Center	outpatient	480.4	240.2	Healthy Blue / Blue Cross NC	North Carolina Medicaid	168.91	103.15	360.3
ED Visit Level 4 – Pro	ED Visit Level 4 – Pro	Medicine	99284	CPT	7500013		Washington Regional Medical Center	outpatient	480.4	240.2	Cigna	North Carolina PPO-PPA Direct	103.15	103.15	360.3
ED Visit Level 4 – Pro	ED Visit Level 4 – Pro	Medicine	99284	CPT	7500013		Washington Regional Medical Center	outpatient	480.4	240.2	Original Medicare	Traditional Medicare Fee-for-Service	225.79	103.15	360.3
EEG	EEG	Medicine	95819	CPT	4001014		Washington Regional Medical Center	outpatient	322	161	Self-Pay	Discounted Cash		99.84	241.5
EEG	EEG	Medicine	95819	CPT	4001014		Washington Regional Medical Center	outpatient	322	161	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	241.5	99.84	241.5
EEG	EEG	Medicine	95819	CPT	4001014		Washington Regional Medical Center	outpatient	322	161	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	141.68	99.84	241.5
EEG	EEG	Medicine	95819	CPT	4001014		Washington Regional Medical Center	outpatient	322	161	Humana	Medicare Advantage HMO/PPO/PFFS	151.34	99.84	241.5
EEG	EEG	Medicine	95819	CPT	4001014		Washington Regional Medical Center	outpatient	322	161	AmeriHealth Caritas North Carolina	NC Medicaid	113.22	99.84	241.5
EEG	EEG	Medicine	95819	CPT	4001014		Washington Regional Medical Center	outpatient	322	161	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	113.22	99.84	241.5
EEG	EEG	Medicine	95819	CPT	4001014		Washington Regional Medical Center	outpatient	322	161	WellCare of North Carolina	North Carolina Medicaid/CHIP	113.22	99.84	241.5
EEG	EEG	Medicine	95819	CPT	4001014		Washington Regional Medical Center	outpatient	322	161	Healthy Blue / Blue Cross NC	North Carolina Medicaid	113.22	99.84	241.5
EEG	EEG	Medicine	95819	CPT	4001014		Washington Regional Medical Center	outpatient	322	161	Cigna	North Carolina PPO-PPA Direct	99.84	99.84	241.5
EEG	EEG	Medicine	95819	CPT	4001014		Washington Regional Medical Center	outpatient	322	161	Original Medicare	Traditional Medicare Fee-for-Service	151.34	99.84	241.5
EKG (REPEAT)	EKG (REPEAT)	Medicine	93005	CPT	5001004		Washington Regional Medical Center	outpatient	284.25	142.13	Self-Pay	Discounted Cash		17.89	213.19
EKG (REPEAT)	EKG (REPEAT)	Medicine	93005	CPT	5001004		Washington Regional Medical Center	outpatient	284.25	142.13	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	213.19	17.89	213.19
EKG (REPEAT)	EKG (REPEAT)	Medicine	93005	CPT	5001004		Washington Regional Medical Center	outpatient	284.25	142.13	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	125.07	17.89	213.19
EKG (REPEAT)	EKG (REPEAT)	Medicine	93005	CPT	5001004		Washington Regional Medical Center	outpatient	284.25	142.13	Humana	Medicare Advantage HMO/PPO/PFFS	133.6	17.89	213.19
EKG (REPEAT)	EKG (REPEAT)	Medicine	93005	CPT	5001004		Washington Regional Medical Center	outpatient	284.25	142.13	AmeriHealth Caritas North Carolina	NC Medicaid	99.94	17.89	213.19
EKG (REPEAT)	EKG (REPEAT)	Medicine	93005	CPT	5001004		Washington Regional Medical Center	outpatient	284.25	142.13	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	99.94	17.89	213.19
EKG (REPEAT)	EKG (REPEAT)	Medicine	93005	CPT	5001004		Washington Regional Medical Center	outpatient	284.25	142.13	WellCare of North Carolina	North Carolina Medicaid/CHIP	99.94	17.89	213.19
EKG (REPEAT)	EKG (REPEAT)	Medicine	93005	CPT	5001004		Washington Regional Medical Center	outpatient	284.25	142.13	Healthy Blue / Blue Cross NC	North Carolina Medicaid	99.94	17.89	213.19
EKG (REPEAT)	EKG (REPEAT)	Medicine	93005	CPT	5001004		Washington Regional Medical Center	outpatient	284.25	142.13	Cigna	North Carolina PPO-PPA Direct	17.89	17.89	213.19
EKG (REPEAT)	EKG (REPEAT)	Medicine	93005	CPT	5001004		Washington Regional Medical Center	outpatient	284.25	142.13	Original Medicare	Traditional Medicare Fee-for-Service	133.6	17.89	213.19
EKG TRACING ONLY	EKG TRACING ONLY	Medicine	93005	CPT	5001001		Washington Regional Medical Center	outpatient	384.25	192.13	Self-Pay	Discounted Cash		17.89	288.19
EKG TRACING ONLY	EKG TRACING ONLY	Medicine	93005	CPT	5001001		Washington Regional Medical Center	outpatient	384.25	192.13	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	288.19	17.89	288.19
EKG TRACING ONLY	EKG TRACING ONLY	Medicine	93005	CPT	5001001		Washington Regional Medical Center	outpatient	384.25	192.13	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	169.07	17.89	288.19
EKG TRACING ONLY	EKG TRACING ONLY	Medicine	93005	CPT	5001001		Washington Regional Medical Center	outpatient	384.25	192.13	Humana	Medicare Advantage HMO/PPO/PFFS	180.6	17.89	288.19
EKG TRACING ONLY	EKG TRACING ONLY	Medicine	93005	CPT	5001001		Washington Regional Medical Center	outpatient	384.25	192.13	AmeriHealth Caritas North Carolina	NC Medicaid	135.1	17.89	288.19
EKG TRACING ONLY	EKG TRACING ONLY	Medicine	93005	CPT	5001001		Washington Regional Medical Center	outpatient	384.25	192.13	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	135.1	17.89	288.19
EKG TRACING ONLY	EKG TRACING ONLY	Medicine	93005	CPT	5001001		Washington Regional Medical Center	outpatient	384.25	192.13	WellCare of North Carolina	North Carolina Medicaid/CHIP	135.1	17.89	288.19
EKG TRACING ONLY	EKG TRACING ONLY	Medicine	93005	CPT	5001001		Washington Regional Medical Center	outpatient	384.25	192.13	Healthy Blue / Blue Cross NC	North Carolina Medicaid	135.1	17.89	288.19
EKG TRACING ONLY	EKG TRACING ONLY	Medicine	93005	CPT	5001001		Washington Regional Medical Center	outpatient	384.25	192.13	Cigna	North Carolina PPO-PPA Direct	17.89	17.89	288.19
EKG TRACING ONLY	EKG TRACING ONLY	Medicine	93005	CPT	5001001		Washington Regional Medical Center	outpatient	384.25	192.13	Original Medicare	Traditional Medicare Fee-for-Service	180.6	17.89	288.19
EKG TRACING ONLY	EKG TRACING ONLY	Medicine	93005	CPT	6001020		Washington Regional Medical Center	outpatient	384.25	192.13	Self-Pay	Discounted Cash		17.89	288.19
EKG TRACING ONLY	EKG TRACING ONLY	Medicine	93005	CPT	6001020		Washington Regional Medical Center	outpatient	384.25	192.13	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	288.19	17.89	288.19
EKG TRACING ONLY	EKG TRACING ONLY	Medicine	93005	CPT	6001020		Washington Regional Medical Center	outpatient	384.25	192.13	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	169.07	17.89	288.19
EKG TRACING ONLY	EKG TRACING ONLY	Medicine	93005	CPT	6001020		Washington Regional Medical Center	outpatient	384.25	192.13	Humana	Medicare Advantage HMO/PPO/PFFS	180.6	17.89	288.19
EKG TRACING ONLY	EKG TRACING ONLY	Medicine	93005	CPT	6001020		Washington Regional Medical Center	outpatient	384.25	192.13	AmeriHealth Caritas North Carolina	NC Medicaid	135.1	17.89	288.19
EKG TRACING ONLY	EKG TRACING ONLY	Medicine	93005	CPT	6001020		Washington Regional Medical Center	outpatient	384.25	192.13	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	135.1	17.89	288.19
EKG TRACING ONLY	EKG TRACING ONLY	Medicine	93005	CPT	6001020		Washington Regional Medical Center	outpatient	384.25	192.13	WellCare of North Carolina	North Carolina Medicaid/CHIP	135.1	17.89	288.19
EKG TRACING ONLY	EKG TRACING ONLY	Medicine	93005	CPT	6001020		Washington Regional Medical Center	outpatient	384.25	192.13	Healthy Blue / Blue Cross NC	North Carolina Medicaid	135.1	17.89	288.19
EKG TRACING ONLY	EKG TRACING ONLY	Medicine	93005	CPT	6001020		Washington Regional Medical Center	outpatient	384.25	192.13	Cigna	North Carolina PPO-PPA Direct	17.89	17.89	288.19
EKG TRACING ONLY	EKG TRACING ONLY	Medicine	93005	CPT	6001020		Washington Regional Medical Center	outpatient	384.25	192.13	Original Medicare	Traditional Medicare Fee-for-Service	180.6	17.89	288.19
ELECTROCARDIOGRAM TRACING FAC	ELECTROCARDIOGRAM TRACING FAC	Medicine	93005	CPT	10239045		Washington Regional Medical Center	outpatient	284.25	142.13	Self-Pay	Discounted Cash		17.89	213.19
ELECTROCARDIOGRAM TRACING FAC	ELECTROCARDIOGRAM TRACING FAC	Medicine	93005	CPT	10239045		Washington Regional Medical Center	outpatient	284.25	142.13	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	213.19	17.89	213.19
ELECTROCARDIOGRAM TRACING FAC	ELECTROCARDIOGRAM TRACING FAC	Medicine	93005	CPT	10239045		Washington Regional Medical Center	outpatient	284.25	142.13	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	125.07	17.89	213.19
ELECTROCARDIOGRAM TRACING FAC	ELECTROCARDIOGRAM TRACING FAC	Medicine	93005	CPT	10239045		Washington Regional Medical Center	outpatient	284.25	142.13	Humana	Medicare Advantage HMO/PPO/PFFS	133.6	17.89	213.19
ELECTROCARDIOGRAM TRACING FAC	ELECTROCARDIOGRAM TRACING FAC	Medicine	93005	CPT	10239045		Washington Regional Medical Center	outpatient	284.25	142.13	AmeriHealth Caritas North Carolina	NC Medicaid	99.94	17.89	213.19
ELECTROCARDIOGRAM TRACING FAC	ELECTROCARDIOGRAM TRACING FAC	Medicine	93005	CPT	10239045		Washington Regional Medical Center	outpatient	284.25	142.13	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	99.94	17.89	213.19
ELECTROCARDIOGRAM TRACING FAC	ELECTROCARDIOGRAM TRACING FAC	Medicine	93005	CPT	10239045		Washington Regional Medical Center	outpatient	284.25	142.13	WellCare of North Carolina	North Carolina Medicaid/CHIP	99.94	17.89	213.19
ELECTROCARDIOGRAM TRACING FAC	ELECTROCARDIOGRAM TRACING FAC	Medicine	93005	CPT	10239045		Washington Regional Medical Center	outpatient	284.25	142.13	Healthy Blue / Blue Cross NC	North Carolina Medicaid	99.94	17.89	213.19
ELECTROCARDIOGRAM TRACING FAC	ELECTROCARDIOGRAM TRACING FAC	Medicine	93005	CPT	10239045		Washington Regional Medical Center	outpatient	284.25	142.13	Cigna	North Carolina PPO-PPA Direct	17.89	17.89	213.19
ELECTROCARDIOGRAM TRACING FAC	ELECTROCARDIOGRAM TRACING FAC	Medicine	93005	CPT	10239045		Washington Regional Medical Center	outpatient	284.25	142.13	Original Medicare	Traditional Medicare Fee-for-Service	133.6	17.89	213.19
EMERG DEPT VISIT HI/URG 99284	EMERG DEPT VISIT HI/URG 99284	Medicine	99284	CPT	2389452		Washington Regional Medical Center	outpatient	480.4	240.2	Self-Pay	Discounted Cash		103.15	360.3
EMERG DEPT VISIT HI/URG 99284	EMERG DEPT VISIT HI/URG 99284	Medicine	99284	CPT	2389452		Washington Regional Medical Center	outpatient	480.4	240.2	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	360.3	103.15	360.3
EMERG DEPT VISIT HI/URG 99284	EMERG DEPT VISIT HI/URG 99284	Medicine	99284	CPT	2389452		Washington Regional Medical Center	outpatient	480.4	240.2	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	211.38	103.15	360.3
EMERG DEPT VISIT HI/URG 99284	EMERG DEPT VISIT HI/URG 99284	Medicine	99284	CPT	2389452		Washington Regional Medical Center	outpatient	480.4	240.2	Humana	Medicare Advantage HMO/PPO/PFFS	225.79	103.15	360.3
EMERG DEPT VISIT HI/URG 99284	EMERG DEPT VISIT HI/URG 99284	Medicine	99284	CPT	2389452		Washington Regional Medical Center	outpatient	480.4	240.2	AmeriHealth Caritas North Carolina	NC Medicaid	168.91	103.15	360.3
EMERG DEPT VISIT HI/URG 99284	EMERG DEPT VISIT HI/URG 99284	Medicine	99284	CPT	2389452		Washington Regional Medical Center	outpatient	480.4	240.2	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	168.91	103.15	360.3
EMERG DEPT VISIT HI/URG 99284	EMERG DEPT VISIT HI/URG 99284	Medicine	99284	CPT	2389452		Washington Regional Medical Center	outpatient	480.4	240.2	WellCare of North Carolina	North Carolina Medicaid/CHIP	168.91	103.15	360.3
EMERG DEPT VISIT HI/URG 99284	EMERG DEPT VISIT HI/URG 99284	Medicine	99284	CPT	2389452		Washington Regional Medical Center	outpatient	480.4	240.2	Healthy Blue / Blue Cross NC	North Carolina Medicaid	168.91	103.15	360.3
EMERG DEPT VISIT HI/URG 99284	EMERG DEPT VISIT HI/URG 99284	Medicine	99284	CPT	2389452		Washington Regional Medical Center	outpatient	480.4	240.2	Cigna	North Carolina PPO-PPA Direct	103.15	103.15	360.3
EMERG DEPT VISIT HI/URG 99284	EMERG DEPT VISIT HI/URG 99284	Medicine	99284	CPT	2389452		Washington Regional Medical Center	outpatient	480.4	240.2	Original Medicare	Traditional Medicare Fee-for-Service	225.79	103.15	360.3
EMERG DEPT VISIT LIM/MIN 99281	EMERG DEPT VISIT LIM/MIN 99281	Medicine	99281	CPT	2389449		Washington Regional Medical Center	outpatient	86.24	43.12	Self-Pay	Discounted Cash		17.76	64.68
EMERG DEPT VISIT LIM/MIN 99281	EMERG DEPT VISIT LIM/MIN 99281	Medicine	99281	CPT	2389449		Washington Regional Medical Center	outpatient	86.24	43.12	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	64.68	17.76	64.68
EMERG DEPT VISIT LIM/MIN 99281	EMERG DEPT VISIT LIM/MIN 99281	Medicine	99281	CPT	2389449		Washington Regional Medical Center	outpatient	86.24	43.12	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	37.95	17.76	64.68
EMERG DEPT VISIT LIM/MIN 99281	EMERG DEPT VISIT LIM/MIN 99281	Medicine	99281	CPT	2389449		Washington Regional Medical Center	outpatient	86.24	43.12	Humana	Medicare Advantage HMO/PPO/PFFS	40.53	17.76	64.68
EMERG DEPT VISIT LIM/MIN 99281	EMERG DEPT VISIT LIM/MIN 99281	Medicine	99281	CPT	2389449		Washington Regional Medical Center	outpatient	86.24	43.12	AmeriHealth Caritas North Carolina	NC Medicaid	30.32	17.76	64.68
EMERG DEPT VISIT LIM/MIN 99281	EMERG DEPT VISIT LIM/MIN 99281	Medicine	99281	CPT	2389449		Washington Regional Medical Center	outpatient	86.24	43.12	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	30.32	17.76	64.68
EMERG DEPT VISIT LIM/MIN 99281	EMERG DEPT VISIT LIM/MIN 99281	Medicine	99281	CPT	2389449		Washington Regional Medical Center	outpatient	86.24	43.12	WellCare of North Carolina	North Carolina Medicaid/CHIP	30.32	17.76	64.68
EMERG DEPT VISIT LIM/MIN 99281	EMERG DEPT VISIT LIM/MIN 99281	Medicine	99281	CPT	2389449		Washington Regional Medical Center	outpatient	86.24	43.12	Healthy Blue / Blue Cross NC	North Carolina Medicaid	30.32	17.76	64.68
EMERG DEPT VISIT LIM/MIN 99281	EMERG DEPT VISIT LIM/MIN 99281	Medicine	99281	CPT	2389449		Washington Regional Medical Center	outpatient	86.24	43.12	Cigna	North Carolina PPO-PPA Direct	17.76	17.76	64.68
EMERG DEPT VISIT LIM/MIN 99281	EMERG DEPT VISIT LIM/MIN 99281	Medicine	99281	CPT	2389449		Washington Regional Medical Center	outpatient	86.24	43.12	Original Medicare	Traditional Medicare Fee-for-Service	40.53	17.76	64.68
EMTALA SCREENING (NOT CVD MCR)	EMTALA SCREENING (NOT CVD MCR)	Medicine	99281	CPT	6001035		Washington Regional Medical Center	outpatient	222.24	111.12	Self-Pay	Discounted Cash		17.76	166.68
EMTALA SCREENING (NOT CVD MCR)	EMTALA SCREENING (NOT CVD MCR)	Medicine	99281	CPT	6001035		Washington Regional Medical Center	outpatient	222.24	111.12	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	166.68	17.76	166.68
EMTALA SCREENING (NOT CVD MCR)	EMTALA SCREENING (NOT CVD MCR)	Medicine	99281	CPT	6001035		Washington Regional Medical Center	outpatient	222.24	111.12	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	97.79	17.76	166.68
EMTALA SCREENING (NOT CVD MCR)	EMTALA SCREENING (NOT CVD MCR)	Medicine	99281	CPT	6001035		Washington Regional Medical Center	outpatient	222.24	111.12	Humana	Medicare Advantage HMO/PPO/PFFS	104.45	17.76	166.68
EMTALA SCREENING (NOT CVD MCR)	EMTALA SCREENING (NOT CVD MCR)	Medicine	99281	CPT	6001035		Washington Regional Medical Center	outpatient	222.24	111.12	AmeriHealth Caritas North Carolina	NC Medicaid	78.14	17.76	166.68
EMTALA SCREENING (NOT CVD MCR)	EMTALA SCREENING (NOT CVD MCR)	Medicine	99281	CPT	6001035		Washington Regional Medical Center	outpatient	222.24	111.12	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	78.14	17.76	166.68
EMTALA SCREENING (NOT CVD MCR)	EMTALA SCREENING (NOT CVD MCR)	Medicine	99281	CPT	6001035		Washington Regional Medical Center	outpatient	222.24	111.12	WellCare of North Carolina	North Carolina Medicaid/CHIP	78.14	17.76	166.68
EMTALA SCREENING (NOT CVD MCR)	EMTALA SCREENING (NOT CVD MCR)	Medicine	99281	CPT	6001035		Washington Regional Medical Center	outpatient	222.24	111.12	Healthy Blue / Blue Cross NC	North Carolina Medicaid	78.14	17.76	166.68
EMTALA SCREENING (NOT CVD MCR)	EMTALA SCREENING (NOT CVD MCR)	Medicine	99281	CPT	6001035		Washington Regional Medical Center	outpatient	222.24	111.12	Cigna	North Carolina PPO-PPA Direct	17.76	17.76	166.68
EMTALA SCREENING (NOT CVD MCR)	EMTALA SCREENING (NOT CVD MCR)	Medicine	99281	CPT	6001035		Washington Regional Medical Center	outpatient	222.24	111.12	Original Medicare	Traditional Medicare Fee-for-Service	104.45	17.76	166.68
ER – LEVEL 1	ER – LEVEL 1	Medicine	99281	CPT	6000009		Washington Regional Medical Center	outpatient	222.24	111.12	Self-Pay	Discounted Cash		17.76	166.68
ER – LEVEL 1	ER – LEVEL 1	Medicine	99281	CPT	6000009		Washington Regional Medical Center	outpatient	222.24	111.12	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	166.68	17.76	166.68
ER – LEVEL 1	ER – LEVEL 1	Medicine	99281	CPT	6000009		Washington Regional Medical Center	outpatient	222.24	111.12	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	97.79	17.76	166.68
ER – LEVEL 1	ER – LEVEL 1	Medicine	99281	CPT	6000009		Washington Regional Medical Center	outpatient	222.24	111.12	Humana	Medicare Advantage HMO/PPO/PFFS	104.45	17.76	166.68
ER – LEVEL 1	ER – LEVEL 1	Medicine	99281	CPT	6000009		Washington Regional Medical Center	outpatient	222.24	111.12	AmeriHealth Caritas North Carolina	NC Medicaid	78.14	17.76	166.68
ER – LEVEL 1	ER – LEVEL 1	Medicine	99281	CPT	6000009		Washington Regional Medical Center	outpatient	222.24	111.12	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	78.14	17.76	166.68
ER – LEVEL 1	ER – LEVEL 1	Medicine	99281	CPT	6000009		Washington Regional Medical Center	outpatient	222.24	111.12	WellCare of North Carolina	North Carolina Medicaid/CHIP	78.14	17.76	166.68
ER – LEVEL 1	ER – LEVEL 1	Medicine	99281	CPT	6000009		Washington Regional Medical Center	outpatient	222.24	111.12	Healthy Blue / Blue Cross NC	North Carolina Medicaid	78.14	17.76	166.68
ER – LEVEL 1	ER – LEVEL 1	Medicine	99281	CPT	6000009		Washington Regional Medical Center	outpatient	222.24	111.12	Cigna	North Carolina PPO-PPA Direct	17.76	17.76	166.68
ER – LEVEL 1	ER – LEVEL 1	Medicine	99281	CPT	6000009		Washington Regional Medical Center	outpatient	222.24	111.12	Original Medicare	Traditional Medicare Fee-for-Service	104.45	17.76	166.68
ER LEVEL 1 (MSE ONLY)	ER LEVEL 1 (MSE ONLY)	Medicine	99281	CPT	6001006		Washington Regional Medical Center	outpatient	222.24	111.12	Self-Pay	Discounted Cash		17.76	166.68
ER LEVEL 1 (MSE ONLY)	ER LEVEL 1 (MSE ONLY)	Medicine	99281	CPT	6001006		Washington Regional Medical Center	outpatient	222.24	111.12	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	166.68	17.76	166.68
ER LEVEL 1 (MSE ONLY)	ER LEVEL 1 (MSE ONLY)	Medicine	99281	CPT	6001006		Washington Regional Medical Center	outpatient	222.24	111.12	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	97.79	17.76	166.68
ER LEVEL 1 (MSE ONLY)	ER LEVEL 1 (MSE ONLY)	Medicine	99281	CPT	6001006		Washington Regional Medical Center	outpatient	222.24	111.12	Humana	Medicare Advantage HMO/PPO/PFFS	104.45	17.76	166.68
ER LEVEL 1 (MSE ONLY)	ER LEVEL 1 (MSE ONLY)	Medicine	99281	CPT	6001006		Washington Regional Medical Center	outpatient	222.24	111.12	AmeriHealth Caritas North Carolina	NC Medicaid	78.14	17.76	166.68
ER LEVEL 1 (MSE ONLY)	ER LEVEL 1 (MSE ONLY)	Medicine	99281	CPT	6001006		Washington Regional Medical Center	outpatient	222.24	111.12	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	78.14	17.76	166.68
ER LEVEL 1 (MSE ONLY)	ER LEVEL 1 (MSE ONLY)	Medicine	99281	CPT	6001006		Washington Regional Medical Center	outpatient	222.24	111.12	WellCare of North Carolina	North Carolina Medicaid/CHIP	78.14	17.76	166.68
ER LEVEL 1 (MSE ONLY)	ER LEVEL 1 (MSE ONLY)	Medicine	99281	CPT	6001006		Washington Regional Medical Center	outpatient	222.24	111.12	Healthy Blue / Blue Cross NC	North Carolina Medicaid	78.14	17.76	166.68
ER LEVEL 1 (MSE ONLY)	ER LEVEL 1 (MSE ONLY)	Medicine	99281	CPT	6001006		Washington Regional Medical Center	outpatient	222.24	111.12	Cigna	North Carolina PPO-PPA Direct	17.76	17.76	166.68
ER LEVEL 1 (MSE ONLY)	ER LEVEL 1 (MSE ONLY)	Medicine	99281	CPT	6001006		Washington Regional Medical Center	outpatient	222.24	111.12	Original Medicare	Traditional Medicare Fee-for-Service	104.45	17.76	166.68
ER LEVEL 1 EVAL	ER LEVEL 1 EVAL	Medicine	99281	CPT	45000010		Washington Regional Medical Center	outpatient	222.24	111.12	Self-Pay	Discounted Cash		17.76	166.68
ER LEVEL 1 EVAL	ER LEVEL 1 EVAL	Medicine	99281	CPT	45000010		Washington Regional Medical Center	outpatient	222.24	111.12	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	166.68	17.76	166.68
ER LEVEL 1 EVAL	ER LEVEL 1 EVAL	Medicine	99281	CPT	45000010		Washington Regional Medical Center	outpatient	222.24	111.12	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	97.79	17.76	166.68
ER LEVEL 1 EVAL	ER LEVEL 1 EVAL	Medicine	99281	CPT	45000010		Washington Regional Medical Center	outpatient	222.24	111.12	Humana	Medicare Advantage HMO/PPO/PFFS	104.45	17.76	166.68
ER LEVEL 1 EVAL	ER LEVEL 1 EVAL	Medicine	99281	CPT	45000010		Washington Regional Medical Center	outpatient	222.24	111.12	AmeriHealth Caritas North Carolina	NC Medicaid	78.14	17.76	166.68
ER LEVEL 1 EVAL	ER LEVEL 1 EVAL	Medicine	99281	CPT	45000010		Washington Regional Medical Center	outpatient	222.24	111.12	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	78.14	17.76	166.68
ER LEVEL 1 EVAL	ER LEVEL 1 EVAL	Medicine	99281	CPT	45000010		Washington Regional Medical Center	outpatient	222.24	111.12	WellCare of North Carolina	North Carolina Medicaid/CHIP	78.14	17.76	166.68
ER LEVEL 1 EVAL	ER LEVEL 1 EVAL	Medicine	99281	CPT	45000010		Washington Regional Medical Center	outpatient	222.24	111.12	Healthy Blue / Blue Cross NC	North Carolina Medicaid	78.14	17.76	166.68
ER LEVEL 1 EVAL	ER LEVEL 1 EVAL	Medicine	99281	CPT	45000010		Washington Regional Medical Center	outpatient	222.24	111.12	Cigna	North Carolina PPO-PPA Direct	17.76	17.76	166.68
ER LEVEL 1 EVAL	ER LEVEL 1 EVAL	Medicine	99281	CPT	45000010		Washington Regional Medical Center	outpatient	222.24	111.12	Original Medicare	Traditional Medicare Fee-for-Service	104.45	17.76	166.68
ER LEVEL 4	ER LEVEL 4	Medicine	99284	CPT	6001306		Washington Regional Medical Center	outpatient	1114.59	557.3	Self-Pay	Discounted Cash		103.15	835.94
ER LEVEL 4	ER LEVEL 4	Medicine	99284	CPT	6001306		Washington Regional Medical Center	outpatient	1114.59	557.3	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	835.94	103.15	835.94
ER LEVEL 4	ER LEVEL 4	Medicine	99284	CPT	6001306		Washington Regional Medical Center	outpatient	1114.59	557.3	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	490.42	103.15	835.94
ER LEVEL 4	ER LEVEL 4	Medicine	99284	CPT	6001306		Washington Regional Medical Center	outpatient	1114.59	557.3	Humana	Medicare Advantage HMO/PPO/PFFS	523.86	103.15	835.94
ER LEVEL 4	ER LEVEL 4	Medicine	99284	CPT	6001306		Washington Regional Medical Center	outpatient	1114.59	557.3	AmeriHealth Caritas North Carolina	NC Medicaid	391.89	103.15	835.94
ER LEVEL 4	ER LEVEL 4	Medicine	99284	CPT	6001306		Washington Regional Medical Center	outpatient	1114.59	557.3	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	391.89	103.15	835.94
ER LEVEL 4	ER LEVEL 4	Medicine	99284	CPT	6001306		Washington Regional Medical Center	outpatient	1114.59	557.3	WellCare of North Carolina	North Carolina Medicaid/CHIP	391.89	103.15	835.94
ER LEVEL 4	ER LEVEL 4	Medicine	99284	CPT	6001306		Washington Regional Medical Center	outpatient	1114.59	557.3	Healthy Blue / Blue Cross NC	North Carolina Medicaid	391.89	103.15	835.94
ER LEVEL 4	ER LEVEL 4	Medicine	99284	CPT	6001306		Washington Regional Medical Center	outpatient	1114.59	557.3	Cigna	North Carolina PPO-PPA Direct	103.15	103.15	835.94
ER LEVEL 4	ER LEVEL 4	Medicine	99284	CPT	6001306		Washington Regional Medical Center	outpatient	1114.59	557.3	Original Medicare	Traditional Medicare Fee-for-Service	523.86	103.15	835.94
ER LEVEL 4 (W/MOD 25)	ER LEVEL 4 (W/MOD 25)	Medicine	99284	CPT	6001009		Washington Regional Medical Center	outpatient	1114.56	557.28	Self-Pay	Discounted Cash		103.15	835.92
ER LEVEL 4 (W/MOD 25)	ER LEVEL 4 (W/MOD 25)	Medicine	99284	CPT	6001009		Washington Regional Medical Center	outpatient	1114.56	557.28	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	835.92	103.15	835.92
ER LEVEL 4 (W/MOD 25)	ER LEVEL 4 (W/MOD 25)	Medicine	99284	CPT	6001009		Washington Regional Medical Center	outpatient	1114.56	557.28	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	490.41	103.15	835.92
ER LEVEL 4 (W/MOD 25)	ER LEVEL 4 (W/MOD 25)	Medicine	99284	CPT	6001009		Washington Regional Medical Center	outpatient	1114.56	557.28	Humana	Medicare Advantage HMO/PPO/PFFS	523.84	103.15	835.92
ER LEVEL 4 (W/MOD 25)	ER LEVEL 4 (W/MOD 25)	Medicine	99284	CPT	6001009		Washington Regional Medical Center	outpatient	1114.56	557.28	AmeriHealth Caritas North Carolina	NC Medicaid	391.88	103.15	835.92
ER LEVEL 4 (W/MOD 25)	ER LEVEL 4 (W/MOD 25)	Medicine	99284	CPT	6001009		Washington Regional Medical Center	outpatient	1114.56	557.28	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	391.88	103.15	835.92
ER LEVEL 4 (W/MOD 25)	ER LEVEL 4 (W/MOD 25)	Medicine	99284	CPT	6001009		Washington Regional Medical Center	outpatient	1114.56	557.28	WellCare of North Carolina	North Carolina Medicaid/CHIP	391.88	103.15	835.92
ER LEVEL 4 (W/MOD 25)	ER LEVEL 4 (W/MOD 25)	Medicine	99284	CPT	6001009		Washington Regional Medical Center	outpatient	1114.56	557.28	Healthy Blue / Blue Cross NC	North Carolina Medicaid	391.88	103.15	835.92
ER LEVEL 4 (W/MOD 25)	ER LEVEL 4 (W/MOD 25)	Medicine	99284	CPT	6001009		Washington Regional Medical Center	outpatient	1114.56	557.28	Cigna	North Carolina PPO-PPA Direct	103.15	103.15	835.92
ER LEVEL 4 (W/MOD 25)	ER LEVEL 4 (W/MOD 25)	Medicine	99284	CPT	6001009		Washington Regional Medical Center	outpatient	1114.56	557.28	Original Medicare	Traditional Medicare Fee-for-Service	523.84	103.15	835.92
ER LEVEL 4 EVAL	ER LEVEL 4 EVAL	Medicine	99284	CPT	45000025		Washington Regional Medical Center	outpatient	1114.56	557.28	Self-Pay	Discounted Cash		103.15	835.92
ER LEVEL 4 EVAL	ER LEVEL 4 EVAL	Medicine	99284	CPT	45000025		Washington Regional Medical Center	outpatient	1114.56	557.28	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	835.92	103.15	835.92
ER LEVEL 4 EVAL	ER LEVEL 4 EVAL	Medicine	99284	CPT	45000025		Washington Regional Medical Center	outpatient	1114.56	557.28	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	490.41	103.15	835.92
ER LEVEL 4 EVAL	ER LEVEL 4 EVAL	Medicine	99284	CPT	45000025		Washington Regional Medical Center	outpatient	1114.56	557.28	Humana	Medicare Advantage HMO/PPO/PFFS	523.84	103.15	835.92
ER LEVEL 4 EVAL	ER LEVEL 4 EVAL	Medicine	99284	CPT	45000025		Washington Regional Medical Center	outpatient	1114.56	557.28	AmeriHealth Caritas North Carolina	NC Medicaid	391.88	103.15	835.92
ER LEVEL 4 EVAL	ER LEVEL 4 EVAL	Medicine	99284	CPT	45000025		Washington Regional Medical Center	outpatient	1114.56	557.28	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	391.88	103.15	835.92
ER LEVEL 4 EVAL	ER LEVEL 4 EVAL	Medicine	99284	CPT	45000025		Washington Regional Medical Center	outpatient	1114.56	557.28	WellCare of North Carolina	North Carolina Medicaid/CHIP	391.88	103.15	835.92
ER LEVEL 4 EVAL	ER LEVEL 4 EVAL	Medicine	99284	CPT	45000025		Washington Regional Medical Center	outpatient	1114.56	557.28	Healthy Blue / Blue Cross NC	North Carolina Medicaid	391.88	103.15	835.92
ER LEVEL 4 EVAL	ER LEVEL 4 EVAL	Medicine	99284	CPT	45000025		Washington Regional Medical Center	outpatient	1114.56	557.28	Cigna	North Carolina PPO-PPA Direct	103.15	103.15	835.92
ER LEVEL 4 EVAL	ER LEVEL 4 EVAL	Medicine	99284	CPT	45000025		Washington Regional Medical Center	outpatient	1114.56	557.28	Original Medicare	Traditional Medicare Fee-for-Service	523.84	103.15	835.92
ER PHYSICIAN LEVEL 1	ER PHYSICIAN LEVEL 1	Medicine	99281	CPT	7501001		Washington Regional Medical Center	outpatient	86.24	43.12	Self-Pay	Discounted Cash		17.76	64.68
ER PHYSICIAN LEVEL 1	ER PHYSICIAN LEVEL 1	Medicine	99281	CPT	7501001		Washington Regional Medical Center	outpatient	86.24	43.12	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	64.68	17.76	64.68
ER PHYSICIAN LEVEL 1	ER PHYSICIAN LEVEL 1	Medicine	99281	CPT	7501001		Washington Regional Medical Center	outpatient	86.24	43.12	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	37.95	17.76	64.68
ER PHYSICIAN LEVEL 1	ER PHYSICIAN LEVEL 1	Medicine	99281	CPT	7501001		Washington Regional Medical Center	outpatient	86.24	43.12	Humana	Medicare Advantage HMO/PPO/PFFS	40.53	17.76	64.68
ER PHYSICIAN LEVEL 1	ER PHYSICIAN LEVEL 1	Medicine	99281	CPT	7501001		Washington Regional Medical Center	outpatient	86.24	43.12	AmeriHealth Caritas North Carolina	NC Medicaid	30.32	17.76	64.68
ER PHYSICIAN LEVEL 1	ER PHYSICIAN LEVEL 1	Medicine	99281	CPT	7501001		Washington Regional Medical Center	outpatient	86.24	43.12	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	30.32	17.76	64.68
ER PHYSICIAN LEVEL 1	ER PHYSICIAN LEVEL 1	Medicine	99281	CPT	7501001		Washington Regional Medical Center	outpatient	86.24	43.12	WellCare of North Carolina	North Carolina Medicaid/CHIP	30.32	17.76	64.68
ER PHYSICIAN LEVEL 1	ER PHYSICIAN LEVEL 1	Medicine	99281	CPT	7501001		Washington Regional Medical Center	outpatient	86.24	43.12	Healthy Blue / Blue Cross NC	North Carolina Medicaid	30.32	17.76	64.68
ER PHYSICIAN LEVEL 1	ER PHYSICIAN LEVEL 1	Medicine	99281	CPT	7501001		Washington Regional Medical Center	outpatient	86.24	43.12	Cigna	North Carolina PPO-PPA Direct	17.76	17.76	64.68
ER PHYSICIAN LEVEL 1	ER PHYSICIAN LEVEL 1	Medicine	99281	CPT	7501001		Washington Regional Medical Center	outpatient	86.24	43.12	Original Medicare	Traditional Medicare Fee-for-Service	40.53	17.76	64.68
HOLTER MONITOR SCAN	HOLTER MONITOR SCAN	Medicine	93226	CPT	5001003		Washington Regional Medical Center	outpatient	575.8	287.9	Self-Pay	Discounted Cash		87.8	431.85
HOLTER MONITOR SCAN	HOLTER MONITOR SCAN	Medicine	93226	CPT	5001003		Washington Regional Medical Center	outpatient	575.8	287.9	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	431.85	87.8	431.85
HOLTER MONITOR SCAN	HOLTER MONITOR SCAN	Medicine	93226	CPT	5001003		Washington Regional Medical Center	outpatient	575.8	287.9	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	253.35	87.8	431.85
HOLTER MONITOR SCAN	HOLTER MONITOR SCAN	Medicine	93226	CPT	5001003		Washington Regional Medical Center	outpatient	575.8	287.9	Humana	Medicare Advantage HMO/PPO/PFFS	270.63	87.8	431.85
HOLTER MONITOR SCAN	HOLTER MONITOR SCAN	Medicine	93226	CPT	5001003		Washington Regional Medical Center	outpatient	575.8	287.9	AmeriHealth Caritas North Carolina	NC Medicaid	202.45	87.8	431.85
HOLTER MONITOR SCAN	HOLTER MONITOR SCAN	Medicine	93226	CPT	5001003		Washington Regional Medical Center	outpatient	575.8	287.9	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	202.45	87.8	431.85
HOLTER MONITOR SCAN	HOLTER MONITOR SCAN	Medicine	93226	CPT	5001003		Washington Regional Medical Center	outpatient	575.8	287.9	WellCare of North Carolina	North Carolina Medicaid/CHIP	202.45	87.8	431.85
HOLTER MONITOR SCAN	HOLTER MONITOR SCAN	Medicine	93226	CPT	5001003		Washington Regional Medical Center	outpatient	575.8	287.9	Healthy Blue / Blue Cross NC	North Carolina Medicaid	202.45	87.8	431.85
HOLTER MONITOR SCAN	HOLTER MONITOR SCAN	Medicine	93226	CPT	5001003		Washington Regional Medical Center	outpatient	575.8	287.9	Cigna	North Carolina PPO-PPA Direct	87.8	87.8	431.85
HOLTER MONITOR SCAN	HOLTER MONITOR SCAN	Medicine	93226	CPT	5001003		Washington Regional Medical Center	outpatient	575.8	287.9	Original Medicare	Traditional Medicare Fee-for-Service	270.63	87.8	431.85
HSPTL DSCH MGT 30 MIN/< 99238	HSPTL DSCH MGT 30 MIN/< 99238	Medicine	99238	CPT	2389437		Washington Regional Medical Center	outpatient	278.6	139.3	Self-Pay	Discounted Cash		75.52	208.95
HSPTL DSCH MGT 30 MIN/< 99238	HSPTL DSCH MGT 30 MIN/< 99238	Medicine	99238	CPT	2389437		Washington Regional Medical Center	outpatient	278.6	139.3	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	208.95	75.52	208.95
HSPTL DSCH MGT 30 MIN/< 99238	HSPTL DSCH MGT 30 MIN/< 99238	Medicine	99238	CPT	2389437		Washington Regional Medical Center	outpatient	278.6	139.3	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	122.58	75.52	208.95
HSPTL DSCH MGT 30 MIN/< 99238	HSPTL DSCH MGT 30 MIN/< 99238	Medicine	99238	CPT	2389437		Washington Regional Medical Center	outpatient	278.6	139.3	Humana	Medicare Advantage HMO/PPO/PFFS	130.94	75.52	208.95
HSPTL DSCH MGT 30 MIN/< 99238	HSPTL DSCH MGT 30 MIN/< 99238	Medicine	99238	CPT	2389437		Washington Regional Medical Center	outpatient	278.6	139.3	AmeriHealth Caritas North Carolina	NC Medicaid	97.96	75.52	208.95
HSPTL DSCH MGT 30 MIN/< 99238	HSPTL DSCH MGT 30 MIN/< 99238	Medicine	99238	CPT	2389437		Washington Regional Medical Center	outpatient	278.6	139.3	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	97.96	75.52	208.95
HSPTL DSCH MGT 30 MIN/< 99238	HSPTL DSCH MGT 30 MIN/< 99238	Medicine	99238	CPT	2389437		Washington Regional Medical Center	outpatient	278.6	139.3	WellCare of North Carolina	North Carolina Medicaid/CHIP	97.96	75.52	208.95
HSPTL DSCH MGT 30 MIN/< 99238	HSPTL DSCH MGT 30 MIN/< 99238	Medicine	99238	CPT	2389437		Washington Regional Medical Center	outpatient	278.6	139.3	Healthy Blue / Blue Cross NC	North Carolina Medicaid	97.96	75.52	208.95
HSPTL DSCH MGT 30 MIN/< 99238	HSPTL DSCH MGT 30 MIN/< 99238	Medicine	99238	CPT	2389437		Washington Regional Medical Center	outpatient	278.6	139.3	Cigna	North Carolina PPO-PPA Direct	75.52	75.52	208.95
HSPTL DSCH MGT 30 MIN/< 99238	HSPTL DSCH MGT 30 MIN/< 99238	Medicine	99238	CPT	2389437		Washington Regional Medical Center	outpatient	278.6	139.3	Original Medicare	Traditional Medicare Fee-for-Service	130.94	75.52	208.95
ICUT ALLERGY TITR-AIRBN 95027	ICUT ALLERGY TITR-AIRBN 95027	Medicine	95027	CPT	2388900		Washington Regional Medical Center	outpatient	100.92	50.46	Self-Pay	Discounted Cash		6.05	75.69
ICUT ALLERGY TITR-AIRBN 95027	ICUT ALLERGY TITR-AIRBN 95027	Medicine	95027	CPT	2388900		Washington Regional Medical Center	outpatient	100.92	50.46	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	75.69	6.05	75.69
ICUT ALLERGY TITR-AIRBN 95027	ICUT ALLERGY TITR-AIRBN 95027	Medicine	95027	CPT	2388900		Washington Regional Medical Center	outpatient	100.92	50.46	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	44.4	6.05	75.69
ICUT ALLERGY TITR-AIRBN 95027	ICUT ALLERGY TITR-AIRBN 95027	Medicine	95027	CPT	2388900		Washington Regional Medical Center	outpatient	100.92	50.46	Humana	Medicare Advantage HMO/PPO/PFFS	47.43	6.05	75.69
ICUT ALLERGY TITR-AIRBN 95027	ICUT ALLERGY TITR-AIRBN 95027	Medicine	95027	CPT	2388900		Washington Regional Medical Center	outpatient	100.92	50.46	AmeriHealth Caritas North Carolina	NC Medicaid	35.48	6.05	75.69
ICUT ALLERGY TITR-AIRBN 95027	ICUT ALLERGY TITR-AIRBN 95027	Medicine	95027	CPT	2388900		Washington Regional Medical Center	outpatient	100.92	50.46	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	35.48	6.05	75.69
ICUT ALLERGY TITR-AIRBN 95027	ICUT ALLERGY TITR-AIRBN 95027	Medicine	95027	CPT	2388900		Washington Regional Medical Center	outpatient	100.92	50.46	WellCare of North Carolina	North Carolina Medicaid/CHIP	35.48	6.05	75.69
ICUT ALLERGY TITR-AIRBN 95027	ICUT ALLERGY TITR-AIRBN 95027	Medicine	95027	CPT	2388900		Washington Regional Medical Center	outpatient	100.92	50.46	Healthy Blue / Blue Cross NC	North Carolina Medicaid	35.48	6.05	75.69
ICUT ALLERGY TITR-AIRBN 95027	ICUT ALLERGY TITR-AIRBN 95027	Medicine	95027	CPT	2388900		Washington Regional Medical Center	outpatient	100.92	50.46	Cigna	North Carolina PPO-PPA Direct	6.05	6.05	75.69
ICUT ALLERGY TITR-AIRBN 95027	ICUT ALLERGY TITR-AIRBN 95027	Medicine	95027	CPT	2388900		Washington Regional Medical Center	outpatient	100.92	50.46	Original Medicare	Traditional Medicare Fee-for-Service	47.43	6.05	75.69
Infs IV Hydration Add Hr 96361	Infs IV Hydration Add Hr 96361	Medicine	96361	CPT	2389273		Washington Regional Medical Center	outpatient	293	146.5	Self-Pay	Discounted Cash		17.54	219.75
Infs IV Hydration Add Hr 96361	Infs IV Hydration Add Hr 96361	Medicine	96361	CPT	2389273		Washington Regional Medical Center	outpatient	293	146.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	219.75	17.54	219.75
Infs IV Hydration Add Hr 96361	Infs IV Hydration Add Hr 96361	Medicine	96361	CPT	2389273		Washington Regional Medical Center	outpatient	293	146.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	128.92	17.54	219.75
Infs IV Hydration Add Hr 96361	Infs IV Hydration Add Hr 96361	Medicine	96361	CPT	2389273		Washington Regional Medical Center	outpatient	293	146.5	Humana	Medicare Advantage HMO/PPO/PFFS	137.71	17.54	219.75
Infs IV Hydration Add Hr 96361	Infs IV Hydration Add Hr 96361	Medicine	96361	CPT	2389273		Washington Regional Medical Center	outpatient	293	146.5	AmeriHealth Caritas North Carolina	NC Medicaid	103.02	17.54	219.75
Infs IV Hydration Add Hr 96361	Infs IV Hydration Add Hr 96361	Medicine	96361	CPT	2389273		Washington Regional Medical Center	outpatient	293	146.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	103.02	17.54	219.75
Infs IV Hydration Add Hr 96361	Infs IV Hydration Add Hr 96361	Medicine	96361	CPT	2389273		Washington Regional Medical Center	outpatient	293	146.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	103.02	17.54	219.75
Infs IV Hydration Add Hr 96361	Infs IV Hydration Add Hr 96361	Medicine	96361	CPT	2389273		Washington Regional Medical Center	outpatient	293	146.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	103.02	17.54	219.75
Infs IV Hydration Add Hr 96361	Infs IV Hydration Add Hr 96361	Medicine	96361	CPT	2389273		Washington Regional Medical Center	outpatient	293	146.5	Cigna	North Carolina PPO-PPA Direct	17.54	17.54	219.75
Infs IV Hydration Add Hr 96361	Infs IV Hydration Add Hr 96361	Medicine	96361	CPT	2389273		Washington Regional Medical Center	outpatient	293	146.5	Original Medicare	Traditional Medicare Fee-for-Service	137.71	17.54	219.75
INIT HOSP CARE/DAY 50 M 99222	INIT HOSP CARE/DAY 50 M 99222	Medicine	99222	CPT	2389426		Washington Regional Medical Center	outpatient	524.96	262.48	Self-Pay	Discounted Cash		120.41	393.72
INIT HOSP CARE/DAY 50 M 99222	INIT HOSP CARE/DAY 50 M 99222	Medicine	99222	CPT	2389426		Washington Regional Medical Center	outpatient	524.96	262.48	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	393.72	120.41	393.72
INIT HOSP CARE/DAY 50 M 99222	INIT HOSP CARE/DAY 50 M 99222	Medicine	99222	CPT	2389426		Washington Regional Medical Center	outpatient	524.96	262.48	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	230.98	120.41	393.72
INIT HOSP CARE/DAY 50 M 99222	INIT HOSP CARE/DAY 50 M 99222	Medicine	99222	CPT	2389426		Washington Regional Medical Center	outpatient	524.96	262.48	Humana	Medicare Advantage HMO/PPO/PFFS	246.73	120.41	393.72
INIT HOSP CARE/DAY 50 M 99222	INIT HOSP CARE/DAY 50 M 99222	Medicine	99222	CPT	2389426		Washington Regional Medical Center	outpatient	524.96	262.48	AmeriHealth Caritas North Carolina	NC Medicaid	184.58	120.41	393.72
INIT HOSP CARE/DAY 50 M 99222	INIT HOSP CARE/DAY 50 M 99222	Medicine	99222	CPT	2389426		Washington Regional Medical Center	outpatient	524.96	262.48	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	184.58	120.41	393.72
INIT HOSP CARE/DAY 50 M 99222	INIT HOSP CARE/DAY 50 M 99222	Medicine	99222	CPT	2389426		Washington Regional Medical Center	outpatient	524.96	262.48	WellCare of North Carolina	North Carolina Medicaid/CHIP	184.58	120.41	393.72
INIT HOSP CARE/DAY 50 M 99222	INIT HOSP CARE/DAY 50 M 99222	Medicine	99222	CPT	2389426		Washington Regional Medical Center	outpatient	524.96	262.48	Healthy Blue / Blue Cross NC	North Carolina Medicaid	184.58	120.41	393.72
INIT HOSP CARE/DAY 50 M 99222	INIT HOSP CARE/DAY 50 M 99222	Medicine	99222	CPT	2389426		Washington Regional Medical Center	outpatient	524.96	262.48	Cigna	North Carolina PPO-PPA Direct	120.41	120.41	393.72
INIT HOSP CARE/DAY 50 M 99222	INIT HOSP CARE/DAY 50 M 99222	Medicine	99222	CPT	2389426		Washington Regional Medical Center	outpatient	524.96	262.48	Original Medicare	Traditional Medicare Fee-for-Service	246.73	120.41	393.72
Init Nursing Facil Cr HI 99306	Init Nursing Facil Cr HI 99306	Medicine	99306	CPT	2727647		Washington Regional Medical Center	outpatient	638.96	319.48	Self-Pay	Discounted Cash		115.11	479.22
Init Nursing Facil Cr HI 99306	Init Nursing Facil Cr HI 99306	Medicine	99306	CPT	2727647		Washington Regional Medical Center	outpatient	638.96	319.48	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	479.22	115.11	479.22
Init Nursing Facil Cr HI 99306	Init Nursing Facil Cr HI 99306	Medicine	99306	CPT	2727647		Washington Regional Medical Center	outpatient	638.96	319.48	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	281.14	115.11	479.22
Init Nursing Facil Cr HI 99306	Init Nursing Facil Cr HI 99306	Medicine	99306	CPT	2727647		Washington Regional Medical Center	outpatient	638.96	319.48	Humana	Medicare Advantage HMO/PPO/PFFS	300.31	115.11	479.22
Init Nursing Facil Cr HI 99306	Init Nursing Facil Cr HI 99306	Medicine	99306	CPT	2727647		Washington Regional Medical Center	outpatient	638.96	319.48	AmeriHealth Caritas North Carolina	NC Medicaid	224.66	115.11	479.22
Init Nursing Facil Cr HI 99306	Init Nursing Facil Cr HI 99306	Medicine	99306	CPT	2727647		Washington Regional Medical Center	outpatient	638.96	319.48	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	224.66	115.11	479.22
Init Nursing Facil Cr HI 99306	Init Nursing Facil Cr HI 99306	Medicine	99306	CPT	2727647		Washington Regional Medical Center	outpatient	638.96	319.48	WellCare of North Carolina	North Carolina Medicaid/CHIP	224.66	115.11	479.22
Init Nursing Facil Cr HI 99306	Init Nursing Facil Cr HI 99306	Medicine	99306	CPT	2727647		Washington Regional Medical Center	outpatient	638.96	319.48	Healthy Blue / Blue Cross NC	North Carolina Medicaid	224.66	115.11	479.22
Init Nursing Facil Cr HI 99306	Init Nursing Facil Cr HI 99306	Medicine	99306	CPT	2727647		Washington Regional Medical Center	outpatient	638.96	319.48	Cigna	North Carolina PPO-PPA Direct	115.11	115.11	479.22
Init Nursing Facil Cr HI 99306	Init Nursing Facil Cr HI 99306	Medicine	99306	CPT	2727647		Washington Regional Medical Center	outpatient	638.96	319.48	Original Medicare	Traditional Medicare Fee-for-Service	300.31	115.11	479.22
Init Nursing Facil Cr LO 99304	Init Nursing Facil Cr LO 99304	Medicine	99304	CPT	7817474		Washington Regional Medical Center	outpatient	344.84	172.42	Self-Pay	Discounted Cash		70.25	258.63
Init Nursing Facil Cr LO 99304	Init Nursing Facil Cr LO 99304	Medicine	99304	CPT	7817474		Washington Regional Medical Center	outpatient	344.84	172.42	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	258.63	70.25	258.63
Init Nursing Facil Cr LO 99304	Init Nursing Facil Cr LO 99304	Medicine	99304	CPT	7817474		Washington Regional Medical Center	outpatient	344.84	172.42	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	151.73	70.25	258.63
Init Nursing Facil Cr LO 99304	Init Nursing Facil Cr LO 99304	Medicine	99304	CPT	7817474		Washington Regional Medical Center	outpatient	344.84	172.42	Humana	Medicare Advantage HMO/PPO/PFFS	162.07	70.25	258.63
Init Nursing Facil Cr LO 99304	Init Nursing Facil Cr LO 99304	Medicine	99304	CPT	7817474		Washington Regional Medical Center	outpatient	344.84	172.42	AmeriHealth Caritas North Carolina	NC Medicaid	121.25	70.25	258.63
Init Nursing Facil Cr LO 99304	Init Nursing Facil Cr LO 99304	Medicine	99304	CPT	7817474		Washington Regional Medical Center	outpatient	344.84	172.42	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	121.25	70.25	258.63
Init Nursing Facil Cr LO 99304	Init Nursing Facil Cr LO 99304	Medicine	99304	CPT	7817474		Washington Regional Medical Center	outpatient	344.84	172.42	WellCare of North Carolina	North Carolina Medicaid/CHIP	121.25	70.25	258.63
Init Nursing Facil Cr LO 99304	Init Nursing Facil Cr LO 99304	Medicine	99304	CPT	7817474		Washington Regional Medical Center	outpatient	344.84	172.42	Healthy Blue / Blue Cross NC	North Carolina Medicaid	121.25	70.25	258.63
Init Nursing Facil Cr LO 99304	Init Nursing Facil Cr LO 99304	Medicine	99304	CPT	7817474		Washington Regional Medical Center	outpatient	344.84	172.42	Cigna	North Carolina PPO-PPA Direct	70.25	70.25	258.63
Init Nursing Facil Cr LO 99304	Init Nursing Facil Cr LO 99304	Medicine	99304	CPT	7817474		Washington Regional Medical Center	outpatient	344.84	172.42	Original Medicare	Traditional Medicare Fee-for-Service	162.07	70.25	258.63
INIT OBSERV CR/DAY 70 M 99220	INIT OBSERV CR/DAY 70 M 99220	Medicine	99220	CPT	2389424		Washington Regional Medical Center	outpatient	695.84	347.92	Self-Pay	Discounted Cash		168.1	521.88
INIT OBSERV CR/DAY 70 M 99220	INIT OBSERV CR/DAY 70 M 99220	Medicine	99220	CPT	2389424		Washington Regional Medical Center	outpatient	695.84	347.92	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	521.88	168.1	521.88
INIT OBSERV CR/DAY 70 M 99220	INIT OBSERV CR/DAY 70 M 99220	Medicine	99220	CPT	2389424		Washington Regional Medical Center	outpatient	695.84	347.92	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	306.17	168.1	521.88
INIT OBSERV CR/DAY 70 M 99220	INIT OBSERV CR/DAY 70 M 99220	Medicine	99220	CPT	2389424		Washington Regional Medical Center	outpatient	695.84	347.92	Humana	Medicare Advantage HMO/PPO/PFFS	327.04	168.1	521.88
INIT OBSERV CR/DAY 70 M 99220	INIT OBSERV CR/DAY 70 M 99220	Medicine	99220	CPT	2389424		Washington Regional Medical Center	outpatient	695.84	347.92	AmeriHealth Caritas North Carolina	NC Medicaid	244.66	168.1	521.88
INIT OBSERV CR/DAY 70 M 99220	INIT OBSERV CR/DAY 70 M 99220	Medicine	99220	CPT	2389424		Washington Regional Medical Center	outpatient	695.84	347.92	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	244.66	168.1	521.88
INIT OBSERV CR/DAY 70 M 99220	INIT OBSERV CR/DAY 70 M 99220	Medicine	99220	CPT	2389424		Washington Regional Medical Center	outpatient	695.84	347.92	WellCare of North Carolina	North Carolina Medicaid/CHIP	244.66	168.1	521.88
INIT OBSERV CR/DAY 70 M 99220	INIT OBSERV CR/DAY 70 M 99220	Medicine	99220	CPT	2389424		Washington Regional Medical Center	outpatient	695.84	347.92	Healthy Blue / Blue Cross NC	North Carolina Medicaid	244.66	168.1	521.88
INIT OBSERV CR/DAY 70 M 99220	INIT OBSERV CR/DAY 70 M 99220	Medicine	99220	CPT	2389424		Washington Regional Medical Center	outpatient	695.84	347.92	Cigna	North Carolina PPO-PPA Direct	168.1	168.1	521.88
INIT OBSERV CR/DAY 70 M 99220	INIT OBSERV CR/DAY 70 M 99220	Medicine	99220	CPT	2389424		Washington Regional Medical Center	outpatient	695.84	347.92	Original Medicare	Traditional Medicare Fee-for-Service	327.04	168.1	521.88
IP DC DAY CARE – 30M OR LESS	IP DC DAY CARE – 30M OR LESS	Medicine	99238	CPT	7500376		Washington Regional Medical Center	outpatient	278.6	139.3	Self-Pay	Discounted Cash		75.52	208.95
IP DC DAY CARE – 30M OR LESS	IP DC DAY CARE – 30M OR LESS	Medicine	99238	CPT	7500376		Washington Regional Medical Center	outpatient	278.6	139.3	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	208.95	75.52	208.95
IP DC DAY CARE – 30M OR LESS	IP DC DAY CARE – 30M OR LESS	Medicine	99238	CPT	7500376		Washington Regional Medical Center	outpatient	278.6	139.3	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	122.58	75.52	208.95
IP DC DAY CARE – 30M OR LESS	IP DC DAY CARE – 30M OR LESS	Medicine	99238	CPT	7500376		Washington Regional Medical Center	outpatient	278.6	139.3	Humana	Medicare Advantage HMO/PPO/PFFS	130.94	75.52	208.95
IP DC DAY CARE – 30M OR LESS	IP DC DAY CARE – 30M OR LESS	Medicine	99238	CPT	7500376		Washington Regional Medical Center	outpatient	278.6	139.3	AmeriHealth Caritas North Carolina	NC Medicaid	97.96	75.52	208.95
IP DC DAY CARE – 30M OR LESS	IP DC DAY CARE – 30M OR LESS	Medicine	99238	CPT	7500376		Washington Regional Medical Center	outpatient	278.6	139.3	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	97.96	75.52	208.95
IP DC DAY CARE – 30M OR LESS	IP DC DAY CARE – 30M OR LESS	Medicine	99238	CPT	7500376		Washington Regional Medical Center	outpatient	278.6	139.3	WellCare of North Carolina	North Carolina Medicaid/CHIP	97.96	75.52	208.95
IP DC DAY CARE – 30M OR LESS	IP DC DAY CARE – 30M OR LESS	Medicine	99238	CPT	7500376		Washington Regional Medical Center	outpatient	278.6	139.3	Healthy Blue / Blue Cross NC	North Carolina Medicaid	97.96	75.52	208.95
IP DC DAY CARE – 30M OR LESS	IP DC DAY CARE – 30M OR LESS	Medicine	99238	CPT	7500376		Washington Regional Medical Center	outpatient	278.6	139.3	Cigna	North Carolina PPO-PPA Direct	75.52	75.52	208.95
IP DC DAY CARE – 30M OR LESS	IP DC DAY CARE – 30M OR LESS	Medicine	99238	CPT	7500376		Washington Regional Medical Center	outpatient	278.6	139.3	Original Medicare	Traditional Medicare Fee-for-Service	130.94	75.52	208.95
IP HOSP SUBQ DAY – LEVEL 1	IP HOSP SUBQ DAY – LEVEL 1	Medicine	99231	CPT	7500374		Washington Regional Medical Center	outpatient	150.4	75.2	Self-Pay	Discounted Cash		36.35	112.8
IP HOSP SUBQ DAY – LEVEL 1	IP HOSP SUBQ DAY – LEVEL 1	Medicine	99231	CPT	7500374		Washington Regional Medical Center	outpatient	150.4	75.2	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	112.8	36.35	112.8
IP HOSP SUBQ DAY – LEVEL 1	IP HOSP SUBQ DAY – LEVEL 1	Medicine	99231	CPT	7500374		Washington Regional Medical Center	outpatient	150.4	75.2	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	66.18	36.35	112.8
IP HOSP SUBQ DAY – LEVEL 1	IP HOSP SUBQ DAY – LEVEL 1	Medicine	99231	CPT	7500374		Washington Regional Medical Center	outpatient	150.4	75.2	Humana	Medicare Advantage HMO/PPO/PFFS	70.69	36.35	112.8
IP HOSP SUBQ DAY – LEVEL 1	IP HOSP SUBQ DAY – LEVEL 1	Medicine	99231	CPT	7500374		Washington Regional Medical Center	outpatient	150.4	75.2	AmeriHealth Caritas North Carolina	NC Medicaid	52.88	36.35	112.8
IP HOSP SUBQ DAY – LEVEL 1	IP HOSP SUBQ DAY – LEVEL 1	Medicine	99231	CPT	7500374		Washington Regional Medical Center	outpatient	150.4	75.2	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	52.88	36.35	112.8
IP HOSP SUBQ DAY – LEVEL 1	IP HOSP SUBQ DAY – LEVEL 1	Medicine	99231	CPT	7500374		Washington Regional Medical Center	outpatient	150.4	75.2	WellCare of North Carolina	North Carolina Medicaid/CHIP	52.88	36.35	112.8
IP HOSP SUBQ DAY – LEVEL 1	IP HOSP SUBQ DAY – LEVEL 1	Medicine	99231	CPT	7500374		Washington Regional Medical Center	outpatient	150.4	75.2	Healthy Blue / Blue Cross NC	North Carolina Medicaid	52.88	36.35	112.8
IP HOSP SUBQ DAY – LEVEL 1	IP HOSP SUBQ DAY – LEVEL 1	Medicine	99231	CPT	7500374		Washington Regional Medical Center	outpatient	150.4	75.2	Cigna	North Carolina PPO-PPA Direct	36.35	36.35	112.8
IP HOSP SUBQ DAY – LEVEL 1	IP HOSP SUBQ DAY – LEVEL 1	Medicine	99231	CPT	7500374		Washington Regional Medical Center	outpatient	150.4	75.2	Original Medicare	Traditional Medicare Fee-for-Service	70.69	36.35	112.8
IV HYDRATION EA ADD HR	IV HYDRATION EA ADD HR	Medicine	96361	CPT	6000035		Washington Regional Medical Center	outpatient	293	146.5	Self-Pay	Discounted Cash		17.54	219.75
IV HYDRATION EA ADD HR	IV HYDRATION EA ADD HR	Medicine	96361	CPT	6000035		Washington Regional Medical Center	outpatient	293	146.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	219.75	17.54	219.75
IV HYDRATION EA ADD HR	IV HYDRATION EA ADD HR	Medicine	96361	CPT	6000035		Washington Regional Medical Center	outpatient	293	146.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	128.92	17.54	219.75
IV HYDRATION EA ADD HR	IV HYDRATION EA ADD HR	Medicine	96361	CPT	6000035		Washington Regional Medical Center	outpatient	293	146.5	Humana	Medicare Advantage HMO/PPO/PFFS	137.71	17.54	219.75
IV HYDRATION EA ADD HR	IV HYDRATION EA ADD HR	Medicine	96361	CPT	6000035		Washington Regional Medical Center	outpatient	293	146.5	AmeriHealth Caritas North Carolina	NC Medicaid	103.02	17.54	219.75
IV HYDRATION EA ADD HR	IV HYDRATION EA ADD HR	Medicine	96361	CPT	6000035		Washington Regional Medical Center	outpatient	293	146.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	103.02	17.54	219.75
IV HYDRATION EA ADD HR	IV HYDRATION EA ADD HR	Medicine	96361	CPT	6000035		Washington Regional Medical Center	outpatient	293	146.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	103.02	17.54	219.75
IV HYDRATION EA ADD HR	IV HYDRATION EA ADD HR	Medicine	96361	CPT	6000035		Washington Regional Medical Center	outpatient	293	146.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	103.02	17.54	219.75
IV HYDRATION EA ADD HR	IV HYDRATION EA ADD HR	Medicine	96361	CPT	6000035		Washington Regional Medical Center	outpatient	293	146.5	Cigna	North Carolina PPO-PPA Direct	17.54	17.54	219.75
IV HYDRATION EA ADD HR	IV HYDRATION EA ADD HR	Medicine	96361	CPT	6000035		Washington Regional Medical Center	outpatient	293	146.5	Original Medicare	Traditional Medicare Fee-for-Service	137.71	17.54	219.75
IV INF ADD SEQ DRUG UP TO 1 HR	IV INF ADD SEQ DRUG UP TO 1 HR	Medicine	96367	CPT	6001060		Washington Regional Medical Center	outpatient	243	121.5	Self-Pay	Discounted Cash		37.14	182.25
IV INF ADD SEQ DRUG UP TO 1 HR	IV INF ADD SEQ DRUG UP TO 1 HR	Medicine	96367	CPT	6001060		Washington Regional Medical Center	outpatient	243	121.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	182.25	37.14	182.25
IV INF ADD SEQ DRUG UP TO 1 HR	IV INF ADD SEQ DRUG UP TO 1 HR	Medicine	96367	CPT	6001060		Washington Regional Medical Center	outpatient	243	121.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	106.92	37.14	182.25
IV INF ADD SEQ DRUG UP TO 1 HR	IV INF ADD SEQ DRUG UP TO 1 HR	Medicine	96367	CPT	6001060		Washington Regional Medical Center	outpatient	243	121.5	Humana	Medicare Advantage HMO/PPO/PFFS	114.21	37.14	182.25
IV INF ADD SEQ DRUG UP TO 1 HR	IV INF ADD SEQ DRUG UP TO 1 HR	Medicine	96367	CPT	6001060		Washington Regional Medical Center	outpatient	243	121.5	AmeriHealth Caritas North Carolina	NC Medicaid	85.44	37.14	182.25
IV INF ADD SEQ DRUG UP TO 1 HR	IV INF ADD SEQ DRUG UP TO 1 HR	Medicine	96367	CPT	6001060		Washington Regional Medical Center	outpatient	243	121.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	85.44	37.14	182.25
IV INF ADD SEQ DRUG UP TO 1 HR	IV INF ADD SEQ DRUG UP TO 1 HR	Medicine	96367	CPT	6001060		Washington Regional Medical Center	outpatient	243	121.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	85.44	37.14	182.25
IV INF ADD SEQ DRUG UP TO 1 HR	IV INF ADD SEQ DRUG UP TO 1 HR	Medicine	96367	CPT	6001060		Washington Regional Medical Center	outpatient	243	121.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	85.44	37.14	182.25
IV INF ADD SEQ DRUG UP TO 1 HR	IV INF ADD SEQ DRUG UP TO 1 HR	Medicine	96367	CPT	6001060		Washington Regional Medical Center	outpatient	243	121.5	Cigna	North Carolina PPO-PPA Direct	37.14	37.14	182.25
IV INF ADD SEQ DRUG UP TO 1 HR	IV INF ADD SEQ DRUG UP TO 1 HR	Medicine	96367	CPT	6001060		Washington Regional Medical Center	outpatient	243	121.5	Original Medicare	Traditional Medicare Fee-for-Service	114.21	37.14	182.25
IV Push each additional sequential same drug	IV Push each additional sequential same drug	Medicine	96376	CPT	6001061		Washington Regional Medical Center	outpatient	187	93.5	Self-Pay	Discounted Cash		14.56	140.25
IV Push each additional sequential same drug	IV Push each additional sequential same drug	Medicine	96376	CPT	6001061		Washington Regional Medical Center	outpatient	187	93.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	140.25	14.56	140.25
IV Push each additional sequential same drug	IV Push each additional sequential same drug	Medicine	96376	CPT	6001061		Washington Regional Medical Center	outpatient	187	93.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	82.28	14.56	140.25
IV Push each additional sequential same drug	IV Push each additional sequential same drug	Medicine	96376	CPT	6001061		Washington Regional Medical Center	outpatient	187	93.5	Humana	Medicare Advantage HMO/PPO/PFFS	87.89	14.56	140.25
IV Push each additional sequential same drug	IV Push each additional sequential same drug	Medicine	96376	CPT	6001061		Washington Regional Medical Center	outpatient	187	93.5	AmeriHealth Caritas North Carolina	NC Medicaid	65.75	14.56	140.25
IV Push each additional sequential same drug	IV Push each additional sequential same drug	Medicine	96376	CPT	6001061		Washington Regional Medical Center	outpatient	187	93.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	65.75	14.56	140.25
IV Push each additional sequential same drug	IV Push each additional sequential same drug	Medicine	96376	CPT	6001061		Washington Regional Medical Center	outpatient	187	93.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	65.75	14.56	140.25
IV Push each additional sequential same drug	IV Push each additional sequential same drug	Medicine	96376	CPT	6001061		Washington Regional Medical Center	outpatient	187	93.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	65.75	14.56	140.25
IV Push each additional sequential same drug	IV Push each additional sequential same drug	Medicine	96376	CPT	6001061		Washington Regional Medical Center	outpatient	187	93.5	Cigna	North Carolina PPO-PPA Direct	14.56	14.56	140.25
IV Push each additional sequential same drug	IV Push each additional sequential same drug	Medicine	96376	CPT	6001061		Washington Regional Medical Center	outpatient	187	93.5	Original Medicare	Traditional Medicare Fee-for-Service	87.89	14.56	140.25
Medication Management 90863	Medication Management 90863	Medicine	90863	CPT	2727575		Washington Regional Medical Center	outpatient	5	2.5	Self-Pay	Discounted Cash		1.76	3.75
Medication Management 90863	Medication Management 90863	Medicine	90863	CPT	2727575		Washington Regional Medical Center	outpatient	5	2.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	3.75	1.76	3.75
Medication Management 90863	Medication Management 90863	Medicine	90863	CPT	2727575		Washington Regional Medical Center	outpatient	5	2.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	2.2	1.76	3.75
Medication Management 90863	Medication Management 90863	Medicine	90863	CPT	2727575		Washington Regional Medical Center	outpatient	5	2.5	Humana	Medicare Advantage HMO/PPO/PFFS	2.35	1.76	3.75
Medication Management 90863	Medication Management 90863	Medicine	90863	CPT	2727575		Washington Regional Medical Center	outpatient	5	2.5	AmeriHealth Caritas North Carolina	NC Medicaid	1.76	1.76	3.75
Medication Management 90863	Medication Management 90863	Medicine	90863	CPT	2727575		Washington Regional Medical Center	outpatient	5	2.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	1.76	1.76	3.75
Medication Management 90863	Medication Management 90863	Medicine	90863	CPT	2727575		Washington Regional Medical Center	outpatient	5	2.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	1.76	1.76	3.75
Medication Management 90863	Medication Management 90863	Medicine	90863	CPT	2727575		Washington Regional Medical Center	outpatient	5	2.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	1.76	1.76	3.75
Medication Management 90863	Medication Management 90863	Medicine	90863	CPT	2727575		Washington Regional Medical Center	outpatient	5	2.5	Original Medicare	Traditional Medicare Fee-for-Service	2.35	1.76	3.75
NURS FAC DSCH MGT >30 M 99316	NURS FAC DSCH MGT >30 M 99316	Medicine	99316	CPT	2389465		Washington Regional Medical Center	outpatient	401.36	200.68	Self-Pay	Discounted Cash		87.15	301.02
NURS FAC DSCH MGT >30 M 99316	NURS FAC DSCH MGT >30 M 99316	Medicine	99316	CPT	2389465		Washington Regional Medical Center	outpatient	401.36	200.68	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	301.02	87.15	301.02
NURS FAC DSCH MGT >30 M 99316	NURS FAC DSCH MGT >30 M 99316	Medicine	99316	CPT	2389465		Washington Regional Medical Center	outpatient	401.36	200.68	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	176.6	87.15	301.02
NURS FAC DSCH MGT >30 M 99316	NURS FAC DSCH MGT >30 M 99316	Medicine	99316	CPT	2389465		Washington Regional Medical Center	outpatient	401.36	200.68	Humana	Medicare Advantage HMO/PPO/PFFS	188.64	87.15	301.02
NURS FAC DSCH MGT >30 M 99316	NURS FAC DSCH MGT >30 M 99316	Medicine	99316	CPT	2389465		Washington Regional Medical Center	outpatient	401.36	200.68	AmeriHealth Caritas North Carolina	NC Medicaid	141.12	87.15	301.02
NURS FAC DSCH MGT >30 M 99316	NURS FAC DSCH MGT >30 M 99316	Medicine	99316	CPT	2389465		Washington Regional Medical Center	outpatient	401.36	200.68	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	141.12	87.15	301.02
NURS FAC DSCH MGT >30 M 99316	NURS FAC DSCH MGT >30 M 99316	Medicine	99316	CPT	2389465		Washington Regional Medical Center	outpatient	401.36	200.68	WellCare of North Carolina	North Carolina Medicaid/CHIP	141.12	87.15	301.02
NURS FAC DSCH MGT >30 M 99316	NURS FAC DSCH MGT >30 M 99316	Medicine	99316	CPT	2389465		Washington Regional Medical Center	outpatient	401.36	200.68	Healthy Blue / Blue Cross NC	North Carolina Medicaid	141.12	87.15	301.02
NURS FAC DSCH MGT >30 M 99316	NURS FAC DSCH MGT >30 M 99316	Medicine	99316	CPT	2389465		Washington Regional Medical Center	outpatient	401.36	200.68	Cigna	North Carolina PPO-PPA Direct	87.15	87.15	301.02
NURS FAC DSCH MGT >30 M 99316	NURS FAC DSCH MGT >30 M 99316	Medicine	99316	CPT	2389465		Washington Regional Medical Center	outpatient	401.36	200.68	Original Medicare	Traditional Medicare Fee-for-Service	188.64	87.15	301.02
OBS D/C DAY MGMT	OBS D/C DAY MGMT	Medicine	99217	CPT	7501163		Washington Regional Medical Center	outpatient	325	162.5	Self-Pay	Discounted Cash		75.4	243.75
OBS D/C DAY MGMT	OBS D/C DAY MGMT	Medicine	99217	CPT	7501163		Washington Regional Medical Center	outpatient	325	162.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	243.75	75.4	243.75
OBS D/C DAY MGMT	OBS D/C DAY MGMT	Medicine	99217	CPT	7501163		Washington Regional Medical Center	outpatient	325	162.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	143	75.4	243.75
OBS D/C DAY MGMT	OBS D/C DAY MGMT	Medicine	99217	CPT	7501163		Washington Regional Medical Center	outpatient	325	162.5	Humana	Medicare Advantage HMO/PPO/PFFS	152.75	75.4	243.75
OBS D/C DAY MGMT	OBS D/C DAY MGMT	Medicine	99217	CPT	7501163		Washington Regional Medical Center	outpatient	325	162.5	AmeriHealth Caritas North Carolina	NC Medicaid	114.27	75.4	243.75
OBS D/C DAY MGMT	OBS D/C DAY MGMT	Medicine	99217	CPT	7501163		Washington Regional Medical Center	outpatient	325	162.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	114.27	75.4	243.75
OBS D/C DAY MGMT	OBS D/C DAY MGMT	Medicine	99217	CPT	7501163		Washington Regional Medical Center	outpatient	325	162.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	114.27	75.4	243.75
OBS D/C DAY MGMT	OBS D/C DAY MGMT	Medicine	99217	CPT	7501163		Washington Regional Medical Center	outpatient	325	162.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	114.27	75.4	243.75
OBS D/C DAY MGMT	OBS D/C DAY MGMT	Medicine	99217	CPT	7501163		Washington Regional Medical Center	outpatient	325	162.5	Cigna	North Carolina PPO-PPA Direct	75.4	75.4	243.75
OBS D/C DAY MGMT	OBS D/C DAY MGMT	Medicine	99217	CPT	7501163		Washington Regional Medical Center	outpatient	325	162.5	Original Medicare	Traditional Medicare Fee-for-Service	152.75	75.4	243.75
OBS INITIAL LEVEL 3 PER DAY	OBS INITIAL LEVEL 3 PER DAY	Medicine	99220	CPT	7501162		Washington Regional Medical Center	outpatient	695.84	347.92	Self-Pay	Discounted Cash		168.1	521.88
OBS INITIAL LEVEL 3 PER DAY	OBS INITIAL LEVEL 3 PER DAY	Medicine	99220	CPT	7501162		Washington Regional Medical Center	outpatient	695.84	347.92	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	521.88	168.1	521.88
OBS INITIAL LEVEL 3 PER DAY	OBS INITIAL LEVEL 3 PER DAY	Medicine	99220	CPT	7501162		Washington Regional Medical Center	outpatient	695.84	347.92	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	306.17	168.1	521.88
OBS INITIAL LEVEL 3 PER DAY	OBS INITIAL LEVEL 3 PER DAY	Medicine	99220	CPT	7501162		Washington Regional Medical Center	outpatient	695.84	347.92	Humana	Medicare Advantage HMO/PPO/PFFS	327.04	168.1	521.88
OBS INITIAL LEVEL 3 PER DAY	OBS INITIAL LEVEL 3 PER DAY	Medicine	99220	CPT	7501162		Washington Regional Medical Center	outpatient	695.84	347.92	AmeriHealth Caritas North Carolina	NC Medicaid	244.66	168.1	521.88
OBS INITIAL LEVEL 3 PER DAY	OBS INITIAL LEVEL 3 PER DAY	Medicine	99220	CPT	7501162		Washington Regional Medical Center	outpatient	695.84	347.92	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	244.66	168.1	521.88
OBS INITIAL LEVEL 3 PER DAY	OBS INITIAL LEVEL 3 PER DAY	Medicine	99220	CPT	7501162		Washington Regional Medical Center	outpatient	695.84	347.92	WellCare of North Carolina	North Carolina Medicaid/CHIP	244.66	168.1	521.88
OBS INITIAL LEVEL 3 PER DAY	OBS INITIAL LEVEL 3 PER DAY	Medicine	99220	CPT	7501162		Washington Regional Medical Center	outpatient	695.84	347.92	Healthy Blue / Blue Cross NC	North Carolina Medicaid	244.66	168.1	521.88
OBS INITIAL LEVEL 3 PER DAY	OBS INITIAL LEVEL 3 PER DAY	Medicine	99220	CPT	7501162		Washington Regional Medical Center	outpatient	695.84	347.92	Cigna	North Carolina PPO-PPA Direct	168.1	168.1	521.88
OBS INITIAL LEVEL 3 PER DAY	OBS INITIAL LEVEL 3 PER DAY	Medicine	99220	CPT	7501162		Washington Regional Medical Center	outpatient	695.84	347.92	Original Medicare	Traditional Medicare Fee-for-Service	327.04	168.1	521.88
OBSERV CARE DSCH MGT 99217	OBSERV CARE DSCH MGT 99217	Medicine	99217	CPT	2389421		Washington Regional Medical Center	outpatient	325	162.5	Self-Pay	Discounted Cash		75.4	243.75
OBSERV CARE DSCH MGT 99217	OBSERV CARE DSCH MGT 99217	Medicine	99217	CPT	2389421		Washington Regional Medical Center	outpatient	325	162.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	243.75	75.4	243.75
OBSERV CARE DSCH MGT 99217	OBSERV CARE DSCH MGT 99217	Medicine	99217	CPT	2389421		Washington Regional Medical Center	outpatient	325	162.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	143	75.4	243.75
OBSERV CARE DSCH MGT 99217	OBSERV CARE DSCH MGT 99217	Medicine	99217	CPT	2389421		Washington Regional Medical Center	outpatient	325	162.5	Humana	Medicare Advantage HMO/PPO/PFFS	152.75	75.4	243.75
OBSERV CARE DSCH MGT 99217	OBSERV CARE DSCH MGT 99217	Medicine	99217	CPT	2389421		Washington Regional Medical Center	outpatient	325	162.5	AmeriHealth Caritas North Carolina	NC Medicaid	114.27	75.4	243.75
OBSERV CARE DSCH MGT 99217	OBSERV CARE DSCH MGT 99217	Medicine	99217	CPT	2389421		Washington Regional Medical Center	outpatient	325	162.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	114.27	75.4	243.75
OBSERV CARE DSCH MGT 99217	OBSERV CARE DSCH MGT 99217	Medicine	99217	CPT	2389421		Washington Regional Medical Center	outpatient	325	162.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	114.27	75.4	243.75
OBSERV CARE DSCH MGT 99217	OBSERV CARE DSCH MGT 99217	Medicine	99217	CPT	2389421		Washington Regional Medical Center	outpatient	325	162.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	114.27	75.4	243.75
OBSERV CARE DSCH MGT 99217	OBSERV CARE DSCH MGT 99217	Medicine	99217	CPT	2389421		Washington Regional Medical Center	outpatient	325	162.5	Cigna	North Carolina PPO-PPA Direct	75.4	75.4	243.75
OBSERV CARE DSCH MGT 99217	OBSERV CARE DSCH MGT 99217	Medicine	99217	CPT	2389421		Washington Regional Medical Center	outpatient	325	162.5	Original Medicare	Traditional Medicare Fee-for-Service	152.75	75.4	243.75
OBSV/IP SAMEDAY CARE 40M 99234	OBSV/IP SAMEDAY CARE 40M 99234	Medicine	99234	CPT	2389434		Washington Regional Medical Center	outpatient	506.48	253.24	Self-Pay	Discounted Cash		144.51	379.86
OBSV/IP SAMEDAY CARE 40M 99234	OBSV/IP SAMEDAY CARE 40M 99234	Medicine	99234	CPT	2389434		Washington Regional Medical Center	outpatient	506.48	253.24	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	379.86	144.51	379.86
OBSV/IP SAMEDAY CARE 40M 99234	OBSV/IP SAMEDAY CARE 40M 99234	Medicine	99234	CPT	2389434		Washington Regional Medical Center	outpatient	506.48	253.24	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	222.85	144.51	379.86
OBSV/IP SAMEDAY CARE 40M 99234	OBSV/IP SAMEDAY CARE 40M 99234	Medicine	99234	CPT	2389434		Washington Regional Medical Center	outpatient	506.48	253.24	Humana	Medicare Advantage HMO/PPO/PFFS	238.05	144.51	379.86
OBSV/IP SAMEDAY CARE 40M 99234	OBSV/IP SAMEDAY CARE 40M 99234	Medicine	99234	CPT	2389434		Washington Regional Medical Center	outpatient	506.48	253.24	AmeriHealth Caritas North Carolina	NC Medicaid	178.08	144.51	379.86
OBSV/IP SAMEDAY CARE 40M 99234	OBSV/IP SAMEDAY CARE 40M 99234	Medicine	99234	CPT	2389434		Washington Regional Medical Center	outpatient	506.48	253.24	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	178.08	144.51	379.86
OBSV/IP SAMEDAY CARE 40M 99234	OBSV/IP SAMEDAY CARE 40M 99234	Medicine	99234	CPT	2389434		Washington Regional Medical Center	outpatient	506.48	253.24	WellCare of North Carolina	North Carolina Medicaid/CHIP	178.08	144.51	379.86
OBSV/IP SAMEDAY CARE 40M 99234	OBSV/IP SAMEDAY CARE 40M 99234	Medicine	99234	CPT	2389434		Washington Regional Medical Center	outpatient	506.48	253.24	Healthy Blue / Blue Cross NC	North Carolina Medicaid	178.08	144.51	379.86
OBSV/IP SAMEDAY CARE 40M 99234	OBSV/IP SAMEDAY CARE 40M 99234	Medicine	99234	CPT	2389434		Washington Regional Medical Center	outpatient	506.48	253.24	Cigna	North Carolina PPO-PPA Direct	144.51	144.51	379.86
OBSV/IP SAMEDAY CARE 40M 99234	OBSV/IP SAMEDAY CARE 40M 99234	Medicine	99234	CPT	2389434		Washington Regional Medical Center	outpatient	506.48	253.24	Original Medicare	Traditional Medicare Fee-for-Service	238.05	144.51	379.86
OCC THER EVAL HIGH COMP 60 MN	OCC THER EVAL HIGH COMP 60 MN	Medicine	97167	CPT	4201061		Washington Regional Medical Center	outpatient	322	161	Self-Pay	Discounted Cash		67.83	241.5
OCC THER EVAL HIGH COMP 60 MN	OCC THER EVAL HIGH COMP 60 MN	Medicine	97167	CPT	4201061		Washington Regional Medical Center	outpatient	322	161	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	241.5	67.83	241.5
OCC THER EVAL HIGH COMP 60 MN	OCC THER EVAL HIGH COMP 60 MN	Medicine	97167	CPT	4201061		Washington Regional Medical Center	outpatient	322	161	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	141.68	67.83	241.5
OCC THER EVAL HIGH COMP 60 MN	OCC THER EVAL HIGH COMP 60 MN	Medicine	97167	CPT	4201061		Washington Regional Medical Center	outpatient	322	161	Humana	Medicare Advantage HMO/PPO/PFFS	151.34	67.83	241.5
OCC THER EVAL HIGH COMP 60 MN	OCC THER EVAL HIGH COMP 60 MN	Medicine	97167	CPT	4201061		Washington Regional Medical Center	outpatient	322	161	AmeriHealth Caritas North Carolina	NC Medicaid	113.22	67.83	241.5
OCC THER EVAL HIGH COMP 60 MN	OCC THER EVAL HIGH COMP 60 MN	Medicine	97167	CPT	4201061		Washington Regional Medical Center	outpatient	322	161	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	72.71	67.83	241.5
OCC THER EVAL HIGH COMP 60 MN	OCC THER EVAL HIGH COMP 60 MN	Medicine	97167	CPT	4201061		Washington Regional Medical Center	outpatient	322	161	WellCare of North Carolina	North Carolina Medicaid/CHIP	113.22	67.83	241.5
OCC THER EVAL HIGH COMP 60 MN	OCC THER EVAL HIGH COMP 60 MN	Medicine	97167	CPT	4201061		Washington Regional Medical Center	outpatient	322	161	Healthy Blue / Blue Cross NC	North Carolina Medicaid	113.22	67.83	241.5
OCC THER EVAL HIGH COMP 60 MN	OCC THER EVAL HIGH COMP 60 MN	Medicine	97167	CPT	4201061		Washington Regional Medical Center	outpatient	322	161	Cigna	North Carolina PPO-PPA Direct	67.83	67.83	241.5
OCC THER EVAL HIGH COMP 60 MN	OCC THER EVAL HIGH COMP 60 MN	Medicine	97167	CPT	4201061		Washington Regional Medical Center	outpatient	322	161	Original Medicare	Traditional Medicare Fee-for-Service	151.34	67.83	241.5
OCC THER EVAL LOW COMP 30 MINS	OCC THER EVAL LOW COMP 30 MINS	Medicine	97165	CPT	4201059		Washington Regional Medical Center	outpatient	277	138.5	Self-Pay	Discounted Cash		67.83	207.75
OCC THER EVAL LOW COMP 30 MINS	OCC THER EVAL LOW COMP 30 MINS	Medicine	97165	CPT	4201059		Washington Regional Medical Center	outpatient	277	138.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	207.75	67.83	207.75
OCC THER EVAL LOW COMP 30 MINS	OCC THER EVAL LOW COMP 30 MINS	Medicine	97165	CPT	4201059		Washington Regional Medical Center	outpatient	277	138.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	121.88	67.83	207.75
OCC THER EVAL LOW COMP 30 MINS	OCC THER EVAL LOW COMP 30 MINS	Medicine	97165	CPT	4201059		Washington Regional Medical Center	outpatient	277	138.5	Humana	Medicare Advantage HMO/PPO/PFFS	130.19	67.83	207.75
OCC THER EVAL LOW COMP 30 MINS	OCC THER EVAL LOW COMP 30 MINS	Medicine	97165	CPT	4201059		Washington Regional Medical Center	outpatient	277	138.5	AmeriHealth Caritas North Carolina	NC Medicaid	97.39	67.83	207.75
OCC THER EVAL LOW COMP 30 MINS	OCC THER EVAL LOW COMP 30 MINS	Medicine	97165	CPT	4201059		Washington Regional Medical Center	outpatient	277	138.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	72.71	67.83	207.75
OCC THER EVAL LOW COMP 30 MINS	OCC THER EVAL LOW COMP 30 MINS	Medicine	97165	CPT	4201059		Washington Regional Medical Center	outpatient	277	138.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	97.39	67.83	207.75
OCC THER EVAL LOW COMP 30 MINS	OCC THER EVAL LOW COMP 30 MINS	Medicine	97165	CPT	4201059		Washington Regional Medical Center	outpatient	277	138.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	97.39	67.83	207.75
OCC THER EVAL LOW COMP 30 MINS	OCC THER EVAL LOW COMP 30 MINS	Medicine	97165	CPT	4201059		Washington Regional Medical Center	outpatient	277	138.5	Cigna	North Carolina PPO-PPA Direct	67.83	67.83	207.75
OCC THER EVAL LOW COMP 30 MINS	OCC THER EVAL LOW COMP 30 MINS	Medicine	97165	CPT	4201059		Washington Regional Medical Center	outpatient	277	138.5	Original Medicare	Traditional Medicare Fee-for-Service	130.19	67.83	207.75
OFC ESTAB LEVEL 1	OFC ESTAB LEVEL 1	Medicine	99211	CPT	8001006		Washington Regional Medical Center	outpatient	89	44.5	Self-Pay	Discounted Cash		9.67	66.75
OFC ESTAB LEVEL 1	OFC ESTAB LEVEL 1	Medicine	99211	CPT	8001006		Washington Regional Medical Center	outpatient	89	44.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	66.75	9.67	66.75
OFC ESTAB LEVEL 1	OFC ESTAB LEVEL 1	Medicine	99211	CPT	8001006		Washington Regional Medical Center	outpatient	89	44.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	39.16	9.67	66.75
OFC ESTAB LEVEL 1	OFC ESTAB LEVEL 1	Medicine	99211	CPT	8001006		Washington Regional Medical Center	outpatient	89	44.5	Humana	Medicare Advantage HMO/PPO/PFFS	41.83	9.67	66.75
OFC ESTAB LEVEL 1	OFC ESTAB LEVEL 1	Medicine	99211	CPT	8001006		Washington Regional Medical Center	outpatient	89	44.5	AmeriHealth Caritas North Carolina	NC Medicaid	31.29	9.67	66.75
OFC ESTAB LEVEL 1	OFC ESTAB LEVEL 1	Medicine	99211	CPT	8001006		Washington Regional Medical Center	outpatient	89	44.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	31.29	9.67	66.75
OFC ESTAB LEVEL 1	OFC ESTAB LEVEL 1	Medicine	99211	CPT	8001006		Washington Regional Medical Center	outpatient	89	44.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	31.29	9.67	66.75
OFC ESTAB LEVEL 1	OFC ESTAB LEVEL 1	Medicine	99211	CPT	8001006		Washington Regional Medical Center	outpatient	89	44.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	31.29	9.67	66.75
OFC ESTAB LEVEL 1	OFC ESTAB LEVEL 1	Medicine	99211	CPT	8001006		Washington Regional Medical Center	outpatient	89	44.5	Cigna	North Carolina PPO-PPA Direct	9.67	9.67	66.75
OFC ESTAB LEVEL 1	OFC ESTAB LEVEL 1	Medicine	99211	CPT	8001006		Washington Regional Medical Center	outpatient	89	44.5	Original Medicare	Traditional Medicare Fee-for-Service	41.83	9.67	66.75
OFC ESTAB LEVEL 3	OFC ESTAB LEVEL 3	Medicine	99213	CPT	8001008		Washington Regional Medical Center	outpatient	200	100	Self-Pay	Discounted Cash		37.99	150
OFC ESTAB LEVEL 3	OFC ESTAB LEVEL 3	Medicine	99213	CPT	8001008		Washington Regional Medical Center	outpatient	200	100	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	150	37.99	150
OFC ESTAB LEVEL 3	OFC ESTAB LEVEL 3	Medicine	99213	CPT	8001008		Washington Regional Medical Center	outpatient	200	100	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	88	37.99	150
OFC ESTAB LEVEL 3	OFC ESTAB LEVEL 3	Medicine	99213	CPT	8001008		Washington Regional Medical Center	outpatient	200	100	Humana	Medicare Advantage HMO/PPO/PFFS	94	37.99	150
OFC ESTAB LEVEL 3	OFC ESTAB LEVEL 3	Medicine	99213	CPT	8001008		Washington Regional Medical Center	outpatient	200	100	AmeriHealth Caritas North Carolina	NC Medicaid	70.32	37.99	150
OFC ESTAB LEVEL 3	OFC ESTAB LEVEL 3	Medicine	99213	CPT	8001008		Washington Regional Medical Center	outpatient	200	100	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	70.32	37.99	150
OFC ESTAB LEVEL 3	OFC ESTAB LEVEL 3	Medicine	99213	CPT	8001008		Washington Regional Medical Center	outpatient	200	100	WellCare of North Carolina	North Carolina Medicaid/CHIP	70.32	37.99	150
OFC ESTAB LEVEL 3	OFC ESTAB LEVEL 3	Medicine	99213	CPT	8001008		Washington Regional Medical Center	outpatient	200	100	Healthy Blue / Blue Cross NC	North Carolina Medicaid	70.32	37.99	150
OFC ESTAB LEVEL 3	OFC ESTAB LEVEL 3	Medicine	99213	CPT	8001008		Washington Regional Medical Center	outpatient	200	100	Cigna	North Carolina PPO-PPA Direct	37.99	37.99	150
OFC ESTAB LEVEL 3	OFC ESTAB LEVEL 3	Medicine	99213	CPT	8001008		Washington Regional Medical Center	outpatient	200	100	Original Medicare	Traditional Medicare Fee-for-Service	94	37.99	150
OFFICE/OUTPT VISIT EST 5 MIN – SPEC CLINIC	OFFICE/OUTPT VISIT EST 5 MIN – SPEC CLINIC	Medicine	99211	CPT	7001098		Washington Regional Medical Center	outpatient	89	44.5	Self-Pay	Discounted Cash		9.67	66.75
OFFICE/OUTPT VISIT EST 5 MIN – SPEC CLINIC	OFFICE/OUTPT VISIT EST 5 MIN – SPEC CLINIC	Medicine	99211	CPT	7001098		Washington Regional Medical Center	outpatient	89	44.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	66.75	9.67	66.75
OFFICE/OUTPT VISIT EST 5 MIN – SPEC CLINIC	OFFICE/OUTPT VISIT EST 5 MIN – SPEC CLINIC	Medicine	99211	CPT	7001098		Washington Regional Medical Center	outpatient	89	44.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	39.16	9.67	66.75
OFFICE/OUTPT VISIT EST 5 MIN – SPEC CLINIC	OFFICE/OUTPT VISIT EST 5 MIN – SPEC CLINIC	Medicine	99211	CPT	7001098		Washington Regional Medical Center	outpatient	89	44.5	Humana	Medicare Advantage HMO/PPO/PFFS	41.83	9.67	66.75
OFFICE/OUTPT VISIT EST 5 MIN – SPEC CLINIC	OFFICE/OUTPT VISIT EST 5 MIN – SPEC CLINIC	Medicine	99211	CPT	7001098		Washington Regional Medical Center	outpatient	89	44.5	AmeriHealth Caritas North Carolina	NC Medicaid	31.29	9.67	66.75
OFFICE/OUTPT VISIT EST 5 MIN – SPEC CLINIC	OFFICE/OUTPT VISIT EST 5 MIN – SPEC CLINIC	Medicine	99211	CPT	7001098		Washington Regional Medical Center	outpatient	89	44.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	31.29	9.67	66.75
OFFICE/OUTPT VISIT EST 5 MIN – SPEC CLINIC	OFFICE/OUTPT VISIT EST 5 MIN – SPEC CLINIC	Medicine	99211	CPT	7001098		Washington Regional Medical Center	outpatient	89	44.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	31.29	9.67	66.75
OFFICE/OUTPT VISIT EST 5 MIN – SPEC CLINIC	OFFICE/OUTPT VISIT EST 5 MIN – SPEC CLINIC	Medicine	99211	CPT	7001098		Washington Regional Medical Center	outpatient	89	44.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	31.29	9.67	66.75
OFFICE/OUTPT VISIT EST 5 MIN – SPEC CLINIC	OFFICE/OUTPT VISIT EST 5 MIN – SPEC CLINIC	Medicine	99211	CPT	7001098		Washington Regional Medical Center	outpatient	89	44.5	Cigna	North Carolina PPO-PPA Direct	9.67	9.67	66.75
OFFICE/OUTPT VISIT EST 5 MIN – SPEC CLINIC	OFFICE/OUTPT VISIT EST 5 MIN – SPEC CLINIC	Medicine	99211	CPT	7001098		Washington Regional Medical Center	outpatient	89	44.5	Original Medicare	Traditional Medicare Fee-for-Service	41.83	9.67	66.75
OMT 3-4 AREAS	OMT 3-4 AREAS	Medicine	98926	CPT	6001255		Washington Regional Medical Center	outpatient	81.72	40.86	Self-Pay	Discounted Cash		28.73	61.29
OMT 3-4 AREAS	OMT 3-4 AREAS	Medicine	98926	CPT	6001255		Washington Regional Medical Center	outpatient	81.72	40.86	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	61.29	28.73	61.29
OMT 3-4 AREAS	OMT 3-4 AREAS	Medicine	98926	CPT	6001255		Washington Regional Medical Center	outpatient	81.72	40.86	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	35.96	28.73	61.29
OMT 3-4 AREAS	OMT 3-4 AREAS	Medicine	98926	CPT	6001255		Washington Regional Medical Center	outpatient	81.72	40.86	Humana	Medicare Advantage HMO/PPO/PFFS	38.41	28.73	61.29
OMT 3-4 AREAS	OMT 3-4 AREAS	Medicine	98926	CPT	6001255		Washington Regional Medical Center	outpatient	81.72	40.86	AmeriHealth Caritas North Carolina	NC Medicaid	28.73	28.73	61.29
OMT 3-4 AREAS	OMT 3-4 AREAS	Medicine	98926	CPT	6001255		Washington Regional Medical Center	outpatient	81.72	40.86	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	28.73	28.73	61.29
OMT 3-4 AREAS	OMT 3-4 AREAS	Medicine	98926	CPT	6001255		Washington Regional Medical Center	outpatient	81.72	40.86	WellCare of North Carolina	North Carolina Medicaid/CHIP	28.73	28.73	61.29
OMT 3-4 AREAS	OMT 3-4 AREAS	Medicine	98926	CPT	6001255		Washington Regional Medical Center	outpatient	81.72	40.86	Healthy Blue / Blue Cross NC	North Carolina Medicaid	28.73	28.73	61.29
OMT 3-4 AREAS	OMT 3-4 AREAS	Medicine	98926	CPT	6001255		Washington Regional Medical Center	outpatient	81.72	40.86	Cigna	North Carolina PPO-PPA Direct	29.01	28.73	61.29
OMT 3-4 AREAS	OMT 3-4 AREAS	Medicine	98926	CPT	6001255		Washington Regional Medical Center	outpatient	81.72	40.86	Original Medicare	Traditional Medicare Fee-for-Service	38.41	28.73	61.29
OP VISIT ESTAB PT EXPAND 15MIN – SPEC CLINIC	OP VISIT ESTAB PT EXPAND 15MIN – SPEC CLINIC	Medicine	99213	CPT	7000016		Washington Regional Medical Center	outpatient	200	100	Self-Pay	Discounted Cash		37.99	150
OP VISIT ESTAB PT EXPAND 15MIN – SPEC CLINIC	OP VISIT ESTAB PT EXPAND 15MIN – SPEC CLINIC	Medicine	99213	CPT	7000016		Washington Regional Medical Center	outpatient	200	100	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	150	37.99	150
OP VISIT ESTAB PT EXPAND 15MIN – SPEC CLINIC	OP VISIT ESTAB PT EXPAND 15MIN – SPEC CLINIC	Medicine	99213	CPT	7000016		Washington Regional Medical Center	outpatient	200	100	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	88	37.99	150
OP VISIT ESTAB PT EXPAND 15MIN – SPEC CLINIC	OP VISIT ESTAB PT EXPAND 15MIN – SPEC CLINIC	Medicine	99213	CPT	7000016		Washington Regional Medical Center	outpatient	200	100	Humana	Medicare Advantage HMO/PPO/PFFS	94	37.99	150
OP VISIT ESTAB PT EXPAND 15MIN – SPEC CLINIC	OP VISIT ESTAB PT EXPAND 15MIN – SPEC CLINIC	Medicine	99213	CPT	7000016		Washington Regional Medical Center	outpatient	200	100	AmeriHealth Caritas North Carolina	NC Medicaid	70.32	37.99	150
OP VISIT ESTAB PT EXPAND 15MIN – SPEC CLINIC	OP VISIT ESTAB PT EXPAND 15MIN – SPEC CLINIC	Medicine	99213	CPT	7000016		Washington Regional Medical Center	outpatient	200	100	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	70.32	37.99	150
OP VISIT ESTAB PT EXPAND 15MIN – SPEC CLINIC	OP VISIT ESTAB PT EXPAND 15MIN – SPEC CLINIC	Medicine	99213	CPT	7000016		Washington Regional Medical Center	outpatient	200	100	WellCare of North Carolina	North Carolina Medicaid/CHIP	70.32	37.99	150
OP VISIT ESTAB PT EXPAND 15MIN – SPEC CLINIC	OP VISIT ESTAB PT EXPAND 15MIN – SPEC CLINIC	Medicine	99213	CPT	7000016		Washington Regional Medical Center	outpatient	200	100	Healthy Blue / Blue Cross NC	North Carolina Medicaid	70.32	37.99	150
OP VISIT ESTAB PT EXPAND 15MIN – SPEC CLINIC	OP VISIT ESTAB PT EXPAND 15MIN – SPEC CLINIC	Medicine	99213	CPT	7000016		Washington Regional Medical Center	outpatient	200	100	Cigna	North Carolina PPO-PPA Direct	37.99	37.99	150
OP VISIT ESTAB PT EXPAND 15MIN – SPEC CLINIC	OP VISIT ESTAB PT EXPAND 15MIN – SPEC CLINIC	Medicine	99213	CPT	7000016		Washington Regional Medical Center	outpatient	200	100	Original Medicare	Traditional Medicare Fee-for-Service	94	37.99	150
OT EVAL/VISIT HIGH	OT EVAL/VISIT HIGH	Medicine	97167	CPT	4201057		Washington Regional Medical Center	outpatient	322	161	Self-Pay	Discounted Cash		67.83	241.5
OT EVAL/VISIT HIGH	OT EVAL/VISIT HIGH	Medicine	97167	CPT	4201057		Washington Regional Medical Center	outpatient	322	161	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	241.5	67.83	241.5
OT EVAL/VISIT HIGH	OT EVAL/VISIT HIGH	Medicine	97167	CPT	4201057		Washington Regional Medical Center	outpatient	322	161	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	141.68	67.83	241.5
OT EVAL/VISIT HIGH	OT EVAL/VISIT HIGH	Medicine	97167	CPT	4201057		Washington Regional Medical Center	outpatient	322	161	Humana	Medicare Advantage HMO/PPO/PFFS	151.34	67.83	241.5
OT EVAL/VISIT HIGH	OT EVAL/VISIT HIGH	Medicine	97167	CPT	4201057		Washington Regional Medical Center	outpatient	322	161	AmeriHealth Caritas North Carolina	NC Medicaid	113.22	67.83	241.5
OT EVAL/VISIT HIGH	OT EVAL/VISIT HIGH	Medicine	97167	CPT	4201057		Washington Regional Medical Center	outpatient	322	161	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	72.71	67.83	241.5
OT EVAL/VISIT HIGH	OT EVAL/VISIT HIGH	Medicine	97167	CPT	4201057		Washington Regional Medical Center	outpatient	322	161	WellCare of North Carolina	North Carolina Medicaid/CHIP	113.22	67.83	241.5
OT EVAL/VISIT HIGH	OT EVAL/VISIT HIGH	Medicine	97167	CPT	4201057		Washington Regional Medical Center	outpatient	322	161	Healthy Blue / Blue Cross NC	North Carolina Medicaid	113.22	67.83	241.5
OT EVAL/VISIT HIGH	OT EVAL/VISIT HIGH	Medicine	97167	CPT	4201057		Washington Regional Medical Center	outpatient	322	161	Cigna	North Carolina PPO-PPA Direct	67.83	67.83	241.5
OT EVAL/VISIT HIGH	OT EVAL/VISIT HIGH	Medicine	97167	CPT	4201057		Washington Regional Medical Center	outpatient	322	161	Original Medicare	Traditional Medicare Fee-for-Service	151.34	67.83	241.5
OT EVAL/VISIT LOW	OT EVAL/VISIT LOW	Medicine	97165	CPT	4201055		Washington Regional Medical Center	outpatient	277	138.5	Self-Pay	Discounted Cash		67.83	207.75
OT EVAL/VISIT LOW	OT EVAL/VISIT LOW	Medicine	97165	CPT	4201055		Washington Regional Medical Center	outpatient	277	138.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	207.75	67.83	207.75
OT EVAL/VISIT LOW	OT EVAL/VISIT LOW	Medicine	97165	CPT	4201055		Washington Regional Medical Center	outpatient	277	138.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	121.88	67.83	207.75
OT EVAL/VISIT LOW	OT EVAL/VISIT LOW	Medicine	97165	CPT	4201055		Washington Regional Medical Center	outpatient	277	138.5	Humana	Medicare Advantage HMO/PPO/PFFS	130.19	67.83	207.75
OT EVAL/VISIT LOW	OT EVAL/VISIT LOW	Medicine	97165	CPT	4201055		Washington Regional Medical Center	outpatient	277	138.5	AmeriHealth Caritas North Carolina	NC Medicaid	97.39	67.83	207.75
OT EVAL/VISIT LOW	OT EVAL/VISIT LOW	Medicine	97165	CPT	4201055		Washington Regional Medical Center	outpatient	277	138.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	72.71	67.83	207.75
OT EVAL/VISIT LOW	OT EVAL/VISIT LOW	Medicine	97165	CPT	4201055		Washington Regional Medical Center	outpatient	277	138.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	97.39	67.83	207.75
OT EVAL/VISIT LOW	OT EVAL/VISIT LOW	Medicine	97165	CPT	4201055		Washington Regional Medical Center	outpatient	277	138.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	97.39	67.83	207.75
OT EVAL/VISIT LOW	OT EVAL/VISIT LOW	Medicine	97165	CPT	4201055		Washington Regional Medical Center	outpatient	277	138.5	Cigna	North Carolina PPO-PPA Direct	67.83	67.83	207.75
OT EVAL/VISIT LOW	OT EVAL/VISIT LOW	Medicine	97165	CPT	4201055		Washington Regional Medical Center	outpatient	277	138.5	Original Medicare	Traditional Medicare Fee-for-Service	130.19	67.83	207.75
OT IONTOPHORESIS/15 MIN	OT IONTOPHORESIS/15 MIN	Medicine	97033	CPT	4201007		Washington Regional Medical Center	outpatient	140	70	Self-Pay	Discounted Cash		16.63	105
OT IONTOPHORESIS/15 MIN	OT IONTOPHORESIS/15 MIN	Medicine	97033	CPT	4201007		Washington Regional Medical Center	outpatient	140	70	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	105	16.63	105
OT IONTOPHORESIS/15 MIN	OT IONTOPHORESIS/15 MIN	Medicine	97033	CPT	4201007		Washington Regional Medical Center	outpatient	140	70	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	61.6	16.63	105
OT IONTOPHORESIS/15 MIN	OT IONTOPHORESIS/15 MIN	Medicine	97033	CPT	4201007		Washington Regional Medical Center	outpatient	140	70	Humana	Medicare Advantage HMO/PPO/PFFS	65.8	16.63	105
OT IONTOPHORESIS/15 MIN	OT IONTOPHORESIS/15 MIN	Medicine	97033	CPT	4201007		Washington Regional Medical Center	outpatient	140	70	AmeriHealth Caritas North Carolina	NC Medicaid	49.22	16.63	105
OT IONTOPHORESIS/15 MIN	OT IONTOPHORESIS/15 MIN	Medicine	97033	CPT	4201007		Washington Regional Medical Center	outpatient	140	70	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	49.22	16.63	105
OT IONTOPHORESIS/15 MIN	OT IONTOPHORESIS/15 MIN	Medicine	97033	CPT	4201007		Washington Regional Medical Center	outpatient	140	70	WellCare of North Carolina	North Carolina Medicaid/CHIP	49.22	16.63	105
OT IONTOPHORESIS/15 MIN	OT IONTOPHORESIS/15 MIN	Medicine	97033	CPT	4201007		Washington Regional Medical Center	outpatient	140	70	Healthy Blue / Blue Cross NC	North Carolina Medicaid	49.22	16.63	105
OT IONTOPHORESIS/15 MIN	OT IONTOPHORESIS/15 MIN	Medicine	97033	CPT	4201007		Washington Regional Medical Center	outpatient	140	70	Cigna	North Carolina PPO-PPA Direct	16.63	16.63	105
OT IONTOPHORESIS/15 MIN	OT IONTOPHORESIS/15 MIN	Medicine	97033	CPT	4201007		Washington Regional Medical Center	outpatient	140	70	Original Medicare	Traditional Medicare Fee-for-Service	65.8	16.63	105
OT MECH TRACTION/VISIT	OT MECH TRACTION/VISIT	Medicine	97012	CPT	4201017		Washington Regional Medical Center	outpatient	99	49.5	Self-Pay	Discounted Cash		12.13	74.25
OT MECH TRACTION/VISIT	OT MECH TRACTION/VISIT	Medicine	97012	CPT	4201017		Washington Regional Medical Center	outpatient	99	49.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	74.25	12.13	74.25
OT MECH TRACTION/VISIT	OT MECH TRACTION/VISIT	Medicine	97012	CPT	4201017		Washington Regional Medical Center	outpatient	99	49.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	43.56	12.13	74.25
OT MECH TRACTION/VISIT	OT MECH TRACTION/VISIT	Medicine	97012	CPT	4201017		Washington Regional Medical Center	outpatient	99	49.5	Humana	Medicare Advantage HMO/PPO/PFFS	46.53	12.13	74.25
OT MECH TRACTION/VISIT	OT MECH TRACTION/VISIT	Medicine	97012	CPT	4201017		Washington Regional Medical Center	outpatient	99	49.5	AmeriHealth Caritas North Carolina	NC Medicaid	34.81	12.13	74.25
OT MECH TRACTION/VISIT	OT MECH TRACTION/VISIT	Medicine	97012	CPT	4201017		Washington Regional Medical Center	outpatient	99	49.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	34.81	12.13	74.25
OT MECH TRACTION/VISIT	OT MECH TRACTION/VISIT	Medicine	97012	CPT	4201017		Washington Regional Medical Center	outpatient	99	49.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	34.81	12.13	74.25
OT MECH TRACTION/VISIT	OT MECH TRACTION/VISIT	Medicine	97012	CPT	4201017		Washington Regional Medical Center	outpatient	99	49.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	34.81	12.13	74.25
OT MECH TRACTION/VISIT	OT MECH TRACTION/VISIT	Medicine	97012	CPT	4201017		Washington Regional Medical Center	outpatient	99	49.5	Cigna	North Carolina PPO-PPA Direct	12.13	12.13	74.25
OT MECH TRACTION/VISIT	OT MECH TRACTION/VISIT	Medicine	97012	CPT	4201017		Washington Regional Medical Center	outpatient	99	49.5	Original Medicare	Traditional Medicare Fee-for-Service	46.53	12.13	74.25
OT NEURO RE-ED/15 MIN	OT NEURO RE-ED/15 MIN	Medicine	97112	CPT	4201010		Washington Regional Medical Center	outpatient	146	73	Self-Pay	Discounted Cash		24.15	109.5
OT NEURO RE-ED/15 MIN	OT NEURO RE-ED/15 MIN	Medicine	97112	CPT	4201010		Washington Regional Medical Center	outpatient	146	73	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	109.5	24.15	109.5
OT NEURO RE-ED/15 MIN	OT NEURO RE-ED/15 MIN	Medicine	97112	CPT	4201010		Washington Regional Medical Center	outpatient	146	73	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	64.24	24.15	109.5
OT NEURO RE-ED/15 MIN	OT NEURO RE-ED/15 MIN	Medicine	97112	CPT	4201010		Washington Regional Medical Center	outpatient	146	73	Humana	Medicare Advantage HMO/PPO/PFFS	68.62	24.15	109.5
OT NEURO RE-ED/15 MIN	OT NEURO RE-ED/15 MIN	Medicine	97112	CPT	4201010		Washington Regional Medical Center	outpatient	146	73	AmeriHealth Caritas North Carolina	NC Medicaid	51.33	24.15	109.5
OT NEURO RE-ED/15 MIN	OT NEURO RE-ED/15 MIN	Medicine	97112	CPT	4201010		Washington Regional Medical Center	outpatient	146	73	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	51.33	24.15	109.5
OT NEURO RE-ED/15 MIN	OT NEURO RE-ED/15 MIN	Medicine	97112	CPT	4201010		Washington Regional Medical Center	outpatient	146	73	WellCare of North Carolina	North Carolina Medicaid/CHIP	51.33	24.15	109.5
OT NEURO RE-ED/15 MIN	OT NEURO RE-ED/15 MIN	Medicine	97112	CPT	4201010		Washington Regional Medical Center	outpatient	146	73	Healthy Blue / Blue Cross NC	North Carolina Medicaid	51.33	24.15	109.5
OT NEURO RE-ED/15 MIN	OT NEURO RE-ED/15 MIN	Medicine	97112	CPT	4201010		Washington Regional Medical Center	outpatient	146	73	Cigna	North Carolina PPO-PPA Direct	24.15	24.15	109.5
OT NEURO RE-ED/15 MIN	OT NEURO RE-ED/15 MIN	Medicine	97112	CPT	4201010		Washington Regional Medical Center	outpatient	146	73	Original Medicare	Traditional Medicare Fee-for-Service	68.62	24.15	109.5
OT PHYS PERFOR TEST/15MIN	OT PHYS PERFOR TEST/15MIN	Medicine	97750	CPT	4201027		Washington Regional Medical Center	outpatient	143	71.5	Self-Pay	Discounted Cash		24.44	107.25
OT PHYS PERFOR TEST/15MIN	OT PHYS PERFOR TEST/15MIN	Medicine	97750	CPT	4201027		Washington Regional Medical Center	outpatient	143	71.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	107.25	24.44	107.25
OT PHYS PERFOR TEST/15MIN	OT PHYS PERFOR TEST/15MIN	Medicine	97750	CPT	4201027		Washington Regional Medical Center	outpatient	143	71.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	62.92	24.44	107.25
OT PHYS PERFOR TEST/15MIN	OT PHYS PERFOR TEST/15MIN	Medicine	97750	CPT	4201027		Washington Regional Medical Center	outpatient	143	71.5	Humana	Medicare Advantage HMO/PPO/PFFS	67.21	24.44	107.25
OT PHYS PERFOR TEST/15MIN	OT PHYS PERFOR TEST/15MIN	Medicine	97750	CPT	4201027		Washington Regional Medical Center	outpatient	143	71.5	AmeriHealth Caritas North Carolina	NC Medicaid	50.28	24.44	107.25
OT PHYS PERFOR TEST/15MIN	OT PHYS PERFOR TEST/15MIN	Medicine	97750	CPT	4201027		Washington Regional Medical Center	outpatient	143	71.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	50.28	24.44	107.25
OT PHYS PERFOR TEST/15MIN	OT PHYS PERFOR TEST/15MIN	Medicine	97750	CPT	4201027		Washington Regional Medical Center	outpatient	143	71.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	50.28	24.44	107.25
OT PHYS PERFOR TEST/15MIN	OT PHYS PERFOR TEST/15MIN	Medicine	97750	CPT	4201027		Washington Regional Medical Center	outpatient	143	71.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	50.28	24.44	107.25
OT PHYS PERFOR TEST/15MIN	OT PHYS PERFOR TEST/15MIN	Medicine	97750	CPT	4201027		Washington Regional Medical Center	outpatient	143	71.5	Cigna	North Carolina PPO-PPA Direct	24.44	24.44	107.25
OT PHYS PERFOR TEST/15MIN	OT PHYS PERFOR TEST/15MIN	Medicine	97750	CPT	4201027		Washington Regional Medical Center	outpatient	143	71.5	Original Medicare	Traditional Medicare Fee-for-Service	67.21	24.44	107.25
OT SELF CARE MGT/15 MIN	OT SELF CARE MGT/15 MIN	Medicine	97535	CPT	4201016		Washington Regional Medical Center	outpatient	105	52.5	Self-Pay	Discounted Cash		24.53	78.75
OT SELF CARE MGT/15 MIN	OT SELF CARE MGT/15 MIN	Medicine	97535	CPT	4201016		Washington Regional Medical Center	outpatient	105	52.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	78.75	24.53	78.75
OT SELF CARE MGT/15 MIN	OT SELF CARE MGT/15 MIN	Medicine	97535	CPT	4201016		Washington Regional Medical Center	outpatient	105	52.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	46.2	24.53	78.75
OT SELF CARE MGT/15 MIN	OT SELF CARE MGT/15 MIN	Medicine	97535	CPT	4201016		Washington Regional Medical Center	outpatient	105	52.5	Humana	Medicare Advantage HMO/PPO/PFFS	49.35	24.53	78.75
OT SELF CARE MGT/15 MIN	OT SELF CARE MGT/15 MIN	Medicine	97535	CPT	4201016		Washington Regional Medical Center	outpatient	105	52.5	AmeriHealth Caritas North Carolina	NC Medicaid	36.92	24.53	78.75
OT SELF CARE MGT/15 MIN	OT SELF CARE MGT/15 MIN	Medicine	97535	CPT	4201016		Washington Regional Medical Center	outpatient	105	52.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	36.92	24.53	78.75
OT SELF CARE MGT/15 MIN	OT SELF CARE MGT/15 MIN	Medicine	97535	CPT	4201016		Washington Regional Medical Center	outpatient	105	52.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	36.92	24.53	78.75
OT SELF CARE MGT/15 MIN	OT SELF CARE MGT/15 MIN	Medicine	97535	CPT	4201016		Washington Regional Medical Center	outpatient	105	52.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	36.92	24.53	78.75
OT SELF CARE MGT/15 MIN	OT SELF CARE MGT/15 MIN	Medicine	97535	CPT	4201016		Washington Regional Medical Center	outpatient	105	52.5	Cigna	North Carolina PPO-PPA Direct	24.53	24.53	78.75
OT SELF CARE MGT/15 MIN	OT SELF CARE MGT/15 MIN	Medicine	97535	CPT	4201016		Washington Regional Medical Center	outpatient	105	52.5	Original Medicare	Traditional Medicare Fee-for-Service	49.35	24.53	78.75
OT THER ACTIS 1 ON 1/15 MIN	OT THER ACTIS 1 ON 1/15 MIN	Medicine	97530	CPT	4201014		Washington Regional Medical Center	outpatient	140	70	Self-Pay	Discounted Cash		24.12	105
OT THER ACTIS 1 ON 1/15 MIN	OT THER ACTIS 1 ON 1/15 MIN	Medicine	97530	CPT	4201014		Washington Regional Medical Center	outpatient	140	70	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	105	24.12	105
OT THER ACTIS 1 ON 1/15 MIN	OT THER ACTIS 1 ON 1/15 MIN	Medicine	97530	CPT	4201014		Washington Regional Medical Center	outpatient	140	70	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	61.6	24.12	105
OT THER ACTIS 1 ON 1/15 MIN	OT THER ACTIS 1 ON 1/15 MIN	Medicine	97530	CPT	4201014		Washington Regional Medical Center	outpatient	140	70	Humana	Medicare Advantage HMO/PPO/PFFS	65.8	24.12	105
OT THER ACTIS 1 ON 1/15 MIN	OT THER ACTIS 1 ON 1/15 MIN	Medicine	97530	CPT	4201014		Washington Regional Medical Center	outpatient	140	70	AmeriHealth Caritas North Carolina	NC Medicaid	49.22	24.12	105
OT THER ACTIS 1 ON 1/15 MIN	OT THER ACTIS 1 ON 1/15 MIN	Medicine	97530	CPT	4201014		Washington Regional Medical Center	outpatient	140	70	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	49.22	24.12	105
OT THER ACTIS 1 ON 1/15 MIN	OT THER ACTIS 1 ON 1/15 MIN	Medicine	97530	CPT	4201014		Washington Regional Medical Center	outpatient	140	70	WellCare of North Carolina	North Carolina Medicaid/CHIP	49.22	24.12	105
OT THER ACTIS 1 ON 1/15 MIN	OT THER ACTIS 1 ON 1/15 MIN	Medicine	97530	CPT	4201014		Washington Regional Medical Center	outpatient	140	70	Healthy Blue / Blue Cross NC	North Carolina Medicaid	49.22	24.12	105
OT THER ACTIS 1 ON 1/15 MIN	OT THER ACTIS 1 ON 1/15 MIN	Medicine	97530	CPT	4201014		Washington Regional Medical Center	outpatient	140	70	Cigna	North Carolina PPO-PPA Direct	24.12	24.12	105
OT THER ACTIS 1 ON 1/15 MIN	OT THER ACTIS 1 ON 1/15 MIN	Medicine	97530	CPT	4201014		Washington Regional Medical Center	outpatient	140	70	Original Medicare	Traditional Medicare Fee-for-Service	65.8	24.12	105
OT VASOPNEUM DEV	OT VASOPNEUM DEV	Medicine	97016	CPT	4201018		Washington Regional Medical Center	outpatient	60	30	Self-Pay	Discounted Cash		11.37	45
OT VASOPNEUM DEV	OT VASOPNEUM DEV	Medicine	97016	CPT	4201018		Washington Regional Medical Center	outpatient	60	30	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	45	11.37	45
OT VASOPNEUM DEV	OT VASOPNEUM DEV	Medicine	97016	CPT	4201018		Washington Regional Medical Center	outpatient	60	30	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	26.4	11.37	45
OT VASOPNEUM DEV	OT VASOPNEUM DEV	Medicine	97016	CPT	4201018		Washington Regional Medical Center	outpatient	60	30	Humana	Medicare Advantage HMO/PPO/PFFS	28.2	11.37	45
OT VASOPNEUM DEV	OT VASOPNEUM DEV	Medicine	97016	CPT	4201018		Washington Regional Medical Center	outpatient	60	30	AmeriHealth Caritas North Carolina	NC Medicaid	21.1	11.37	45
OT VASOPNEUM DEV	OT VASOPNEUM DEV	Medicine	97016	CPT	4201018		Washington Regional Medical Center	outpatient	60	30	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	21.1	11.37	45
OT VASOPNEUM DEV	OT VASOPNEUM DEV	Medicine	97016	CPT	4201018		Washington Regional Medical Center	outpatient	60	30	WellCare of North Carolina	North Carolina Medicaid/CHIP	21.1	11.37	45
OT VASOPNEUM DEV	OT VASOPNEUM DEV	Medicine	97016	CPT	4201018		Washington Regional Medical Center	outpatient	60	30	Healthy Blue / Blue Cross NC	North Carolina Medicaid	21.1	11.37	45
OT VASOPNEUM DEV	OT VASOPNEUM DEV	Medicine	97016	CPT	4201018		Washington Regional Medical Center	outpatient	60	30	Cigna	North Carolina PPO-PPA Direct	11.37	11.37	45
OT VASOPNEUM DEV	OT VASOPNEUM DEV	Medicine	97016	CPT	4201018		Washington Regional Medical Center	outpatient	60	30	Original Medicare	Traditional Medicare Fee-for-Service	28.2	11.37	45
Otolaryngologic Exm GnAn 92502	Otolaryngologic Exm GnAn 92502	Medicine	92502	CPT	2388558		Washington Regional Medical Center	outpatient	370.64	185.32	Self-Pay	Discounted Cash		107.08	277.98
Otolaryngologic Exm GnAn 92502	Otolaryngologic Exm GnAn 92502	Medicine	92502	CPT	2388558		Washington Regional Medical Center	outpatient	370.64	185.32	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	277.98	107.08	277.98
Otolaryngologic Exm GnAn 92502	Otolaryngologic Exm GnAn 92502	Medicine	92502	CPT	2388558		Washington Regional Medical Center	outpatient	370.64	185.32	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	163.08	107.08	277.98
Otolaryngologic Exm GnAn 92502	Otolaryngologic Exm GnAn 92502	Medicine	92502	CPT	2388558		Washington Regional Medical Center	outpatient	370.64	185.32	Humana	Medicare Advantage HMO/PPO/PFFS	174.2	107.08	277.98
Otolaryngologic Exm GnAn 92502	Otolaryngologic Exm GnAn 92502	Medicine	92502	CPT	2388558		Washington Regional Medical Center	outpatient	370.64	185.32	AmeriHealth Caritas North Carolina	NC Medicaid	130.32	107.08	277.98
Otolaryngologic Exm GnAn 92502	Otolaryngologic Exm GnAn 92502	Medicine	92502	CPT	2388558		Washington Regional Medical Center	outpatient	370.64	185.32	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	130.32	107.08	277.98
Otolaryngologic Exm GnAn 92502	Otolaryngologic Exm GnAn 92502	Medicine	92502	CPT	2388558		Washington Regional Medical Center	outpatient	370.64	185.32	WellCare of North Carolina	North Carolina Medicaid/CHIP	130.32	107.08	277.98
Otolaryngologic Exm GnAn 92502	Otolaryngologic Exm GnAn 92502	Medicine	92502	CPT	2388558		Washington Regional Medical Center	outpatient	370.64	185.32	Healthy Blue / Blue Cross NC	North Carolina Medicaid	130.32	107.08	277.98
Otolaryngologic Exm GnAn 92502	Otolaryngologic Exm GnAn 92502	Medicine	92502	CPT	2388558		Washington Regional Medical Center	outpatient	370.64	185.32	Cigna	North Carolina PPO-PPA Direct	107.08	107.08	277.98
Otolaryngologic Exm GnAn 92502	Otolaryngologic Exm GnAn 92502	Medicine	92502	CPT	2388558		Washington Regional Medical Center	outpatient	370.64	185.32	Original Medicare	Traditional Medicare Fee-for-Service	174.2	107.08	277.98
PERCUT ALLERGY SKIN TSTS 95004	PERCUT ALLERGY SKIN TSTS 95004	Medicine	95004	CPT	10225030		Washington Regional Medical Center	outpatient	15.36	7.68	Self-Pay	Discounted Cash		4.12	11.52
PERCUT ALLERGY SKIN TSTS 95004	PERCUT ALLERGY SKIN TSTS 95004	Medicine	95004	CPT	10225030		Washington Regional Medical Center	outpatient	15.36	7.68	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	11.52	4.12	11.52
PERCUT ALLERGY SKIN TSTS 95004	PERCUT ALLERGY SKIN TSTS 95004	Medicine	95004	CPT	10225030		Washington Regional Medical Center	outpatient	15.36	7.68	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	6.76	4.12	11.52
PERCUT ALLERGY SKIN TSTS 95004	PERCUT ALLERGY SKIN TSTS 95004	Medicine	95004	CPT	10225030		Washington Regional Medical Center	outpatient	15.36	7.68	Humana	Medicare Advantage HMO/PPO/PFFS	7.22	4.12	11.52
PERCUT ALLERGY SKIN TSTS 95004	PERCUT ALLERGY SKIN TSTS 95004	Medicine	95004	CPT	10225030		Washington Regional Medical Center	outpatient	15.36	7.68	AmeriHealth Caritas North Carolina	NC Medicaid	5.4	4.12	11.52
PERCUT ALLERGY SKIN TSTS 95004	PERCUT ALLERGY SKIN TSTS 95004	Medicine	95004	CPT	10225030		Washington Regional Medical Center	outpatient	15.36	7.68	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	5.4	4.12	11.52
PERCUT ALLERGY SKIN TSTS 95004	PERCUT ALLERGY SKIN TSTS 95004	Medicine	95004	CPT	10225030		Washington Regional Medical Center	outpatient	15.36	7.68	WellCare of North Carolina	North Carolina Medicaid/CHIP	5.4	4.12	11.52
PERCUT ALLERGY SKIN TSTS 95004	PERCUT ALLERGY SKIN TSTS 95004	Medicine	95004	CPT	10225030		Washington Regional Medical Center	outpatient	15.36	7.68	Healthy Blue / Blue Cross NC	North Carolina Medicaid	5.4	4.12	11.52
PERCUT ALLERGY SKIN TSTS 95004	PERCUT ALLERGY SKIN TSTS 95004	Medicine	95004	CPT	10225030		Washington Regional Medical Center	outpatient	15.36	7.68	Cigna	North Carolina PPO-PPA Direct	4.12	4.12	11.52
PERCUT ALLERGY SKIN TSTS 95004	PERCUT ALLERGY SKIN TSTS 95004	Medicine	95004	CPT	10225030		Washington Regional Medical Center	outpatient	15.36	7.68	Original Medicare	Traditional Medicare Fee-for-Service	7.22	4.12	11.52
PHYS SUBSEQ SWING/NH HIG	PHYS SUBSEQ SWING/NH HIG	Medicine	99309	CPT	7500393		Washington Regional Medical Center	outpatient	350.48	175.24	Self-Pay	Discounted Cash		84.7	262.86
PHYS SUBSEQ SWING/NH HIG	PHYS SUBSEQ SWING/NH HIG	Medicine	99309	CPT	7500393		Washington Regional Medical Center	outpatient	350.48	175.24	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	262.86	84.7	262.86
PHYS SUBSEQ SWING/NH HIG	PHYS SUBSEQ SWING/NH HIG	Medicine	99309	CPT	7500393		Washington Regional Medical Center	outpatient	350.48	175.24	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	154.21	84.7	262.86
PHYS SUBSEQ SWING/NH HIG	PHYS SUBSEQ SWING/NH HIG	Medicine	99309	CPT	7500393		Washington Regional Medical Center	outpatient	350.48	175.24	Humana	Medicare Advantage HMO/PPO/PFFS	164.73	84.7	262.86
PHYS SUBSEQ SWING/NH HIG	PHYS SUBSEQ SWING/NH HIG	Medicine	99309	CPT	7500393		Washington Regional Medical Center	outpatient	350.48	175.24	AmeriHealth Caritas North Carolina	NC Medicaid	123.23	84.7	262.86
PHYS SUBSEQ SWING/NH HIG	PHYS SUBSEQ SWING/NH HIG	Medicine	99309	CPT	7500393		Washington Regional Medical Center	outpatient	350.48	175.24	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	123.23	84.7	262.86
PHYS SUBSEQ SWING/NH HIG	PHYS SUBSEQ SWING/NH HIG	Medicine	99309	CPT	7500393		Washington Regional Medical Center	outpatient	350.48	175.24	WellCare of North Carolina	North Carolina Medicaid/CHIP	123.23	84.7	262.86
PHYS SUBSEQ SWING/NH HIG	PHYS SUBSEQ SWING/NH HIG	Medicine	99309	CPT	7500393		Washington Regional Medical Center	outpatient	350.48	175.24	Healthy Blue / Blue Cross NC	North Carolina Medicaid	123.23	84.7	262.86
PHYS SUBSEQ SWING/NH HIG	PHYS SUBSEQ SWING/NH HIG	Medicine	99309	CPT	7500393		Washington Regional Medical Center	outpatient	350.48	175.24	Cigna	North Carolina PPO-PPA Direct	84.7	84.7	262.86
PHYS SUBSEQ SWING/NH HIG	PHYS SUBSEQ SWING/NH HIG	Medicine	99309	CPT	7500393		Washington Regional Medical Center	outpatient	350.48	175.24	Original Medicare	Traditional Medicare Fee-for-Service	164.73	84.7	262.86
PHYS THER EVAL MOD COMP 30 MIN	PHYS THER EVAL MOD COMP 30 MIN	Medicine	97162	CPT	4201023		Washington Regional Medical Center	outpatient	304	152	Self-Pay	Discounted Cash		69.92	228
PHYS THER EVAL MOD COMP 30 MIN	PHYS THER EVAL MOD COMP 30 MIN	Medicine	97162	CPT	4201023		Washington Regional Medical Center	outpatient	304	152	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	228	69.92	228
PHYS THER EVAL MOD COMP 30 MIN	PHYS THER EVAL MOD COMP 30 MIN	Medicine	97162	CPT	4201023		Washington Regional Medical Center	outpatient	304	152	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	133.76	69.92	228
PHYS THER EVAL MOD COMP 30 MIN	PHYS THER EVAL MOD COMP 30 MIN	Medicine	97162	CPT	4201023		Washington Regional Medical Center	outpatient	304	152	Humana	Medicare Advantage HMO/PPO/PFFS	142.88	69.92	228
PHYS THER EVAL MOD COMP 30 MIN	PHYS THER EVAL MOD COMP 30 MIN	Medicine	97162	CPT	4201023		Washington Regional Medical Center	outpatient	304	152	AmeriHealth Caritas North Carolina	NC Medicaid	106.89	69.92	228
PHYS THER EVAL MOD COMP 30 MIN	PHYS THER EVAL MOD COMP 30 MIN	Medicine	97162	CPT	4201023		Washington Regional Medical Center	outpatient	304	152	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	106.89	69.92	228
PHYS THER EVAL MOD COMP 30 MIN	PHYS THER EVAL MOD COMP 30 MIN	Medicine	97162	CPT	4201023		Washington Regional Medical Center	outpatient	304	152	WellCare of North Carolina	North Carolina Medicaid/CHIP	106.89	69.92	228
PHYS THER EVAL MOD COMP 30 MIN	PHYS THER EVAL MOD COMP 30 MIN	Medicine	97162	CPT	4201023		Washington Regional Medical Center	outpatient	304	152	Healthy Blue / Blue Cross NC	North Carolina Medicaid	106.89	69.92	228
PHYS THER EVAL MOD COMP 30 MIN	PHYS THER EVAL MOD COMP 30 MIN	Medicine	97162	CPT	4201023		Washington Regional Medical Center	outpatient	304	152	Cigna	North Carolina PPO-PPA Direct	69.92	69.92	228
PHYS THER EVAL MOD COMP 30 MIN	PHYS THER EVAL MOD COMP 30 MIN	Medicine	97162	CPT	4201023		Washington Regional Medical Center	outpatient	304	152	Original Medicare	Traditional Medicare Fee-for-Service	142.88	69.92	228
PHYS THER EVAL MOD COMP 30 MN	PHYS THER EVAL MOD COMP 30 MN	Medicine	97162	CPT	4101015		Washington Regional Medical Center	outpatient	304	152	Self-Pay	Discounted Cash		69.92	228
PHYS THER EVAL MOD COMP 30 MN	PHYS THER EVAL MOD COMP 30 MN	Medicine	97162	CPT	4101015		Washington Regional Medical Center	outpatient	304	152	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	228	69.92	228
PHYS THER EVAL MOD COMP 30 MN	PHYS THER EVAL MOD COMP 30 MN	Medicine	97162	CPT	4101015		Washington Regional Medical Center	outpatient	304	152	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	133.76	69.92	228
PHYS THER EVAL MOD COMP 30 MN	PHYS THER EVAL MOD COMP 30 MN	Medicine	97162	CPT	4101015		Washington Regional Medical Center	outpatient	304	152	Humana	Medicare Advantage HMO/PPO/PFFS	142.88	69.92	228
PHYS THER EVAL MOD COMP 30 MN	PHYS THER EVAL MOD COMP 30 MN	Medicine	97162	CPT	4101015		Washington Regional Medical Center	outpatient	304	152	AmeriHealth Caritas North Carolina	NC Medicaid	106.89	69.92	228
PHYS THER EVAL MOD COMP 30 MN	PHYS THER EVAL MOD COMP 30 MN	Medicine	97162	CPT	4101015		Washington Regional Medical Center	outpatient	304	152	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	106.89	69.92	228
PHYS THER EVAL MOD COMP 30 MN	PHYS THER EVAL MOD COMP 30 MN	Medicine	97162	CPT	4101015		Washington Regional Medical Center	outpatient	304	152	WellCare of North Carolina	North Carolina Medicaid/CHIP	106.89	69.92	228
PHYS THER EVAL MOD COMP 30 MN	PHYS THER EVAL MOD COMP 30 MN	Medicine	97162	CPT	4101015		Washington Regional Medical Center	outpatient	304	152	Healthy Blue / Blue Cross NC	North Carolina Medicaid	106.89	69.92	228
PHYS THER EVAL MOD COMP 30 MN	PHYS THER EVAL MOD COMP 30 MN	Medicine	97162	CPT	4101015		Washington Regional Medical Center	outpatient	304	152	Cigna	North Carolina PPO-PPA Direct	69.92	69.92	228
PHYS THER EVAL MOD COMP 30 MN	PHYS THER EVAL MOD COMP 30 MN	Medicine	97162	CPT	4101015		Washington Regional Medical Center	outpatient	304	152	Original Medicare	Traditional Medicare Fee-for-Service	142.88	69.92	228
Psych Complex Interactv 90785	Psych Complex Interactv 90785	Medicine	90785	CPT	2388416		Washington Regional Medical Center	outpatient	58.36	29.18	Self-Pay	Discounted Cash		5.62	43.77
Psych Complex Interactv 90785	Psych Complex Interactv 90785	Medicine	90785	CPT	2388416		Washington Regional Medical Center	outpatient	58.36	29.18	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	43.77	5.62	43.77
Psych Complex Interactv 90785	Psych Complex Interactv 90785	Medicine	90785	CPT	2388416		Washington Regional Medical Center	outpatient	58.36	29.18	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	25.68	5.62	43.77
Psych Complex Interactv 90785	Psych Complex Interactv 90785	Medicine	90785	CPT	2388416		Washington Regional Medical Center	outpatient	58.36	29.18	Humana	Medicare Advantage HMO/PPO/PFFS	27.43	5.62	43.77
Psych Complex Interactv 90785	Psych Complex Interactv 90785	Medicine	90785	CPT	2388416		Washington Regional Medical Center	outpatient	58.36	29.18	AmeriHealth Caritas North Carolina	NC Medicaid	20.52	5.62	43.77
Psych Complex Interactv 90785	Psych Complex Interactv 90785	Medicine	90785	CPT	2388416		Washington Regional Medical Center	outpatient	58.36	29.18	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	20.52	5.62	43.77
Psych Complex Interactv 90785	Psych Complex Interactv 90785	Medicine	90785	CPT	2388416		Washington Regional Medical Center	outpatient	58.36	29.18	WellCare of North Carolina	North Carolina Medicaid/CHIP	20.52	5.62	43.77
Psych Complex Interactv 90785	Psych Complex Interactv 90785	Medicine	90785	CPT	2388416		Washington Regional Medical Center	outpatient	58.36	29.18	Healthy Blue / Blue Cross NC	North Carolina Medicaid	20.52	5.62	43.77
Psych Complex Interactv 90785	Psych Complex Interactv 90785	Medicine	90785	CPT	2388416		Washington Regional Medical Center	outpatient	58.36	29.18	Cigna	North Carolina PPO-PPA Direct	5.62	5.62	43.77
Psych Complex Interactv 90785	Psych Complex Interactv 90785	Medicine	90785	CPT	2388416		Washington Regional Medical Center	outpatient	58.36	29.18	Original Medicare	Traditional Medicare Fee-for-Service	27.43	5.62	43.77
Psych Dx Eval w/Med Serv 90792	Psych Dx Eval w/Med Serv 90792	Medicine	90792	CPT	2388418		Washington Regional Medical Center	outpatient	320	160	Self-Pay	Discounted Cash		112.51	240
Psych Dx Eval w/Med Serv 90792	Psych Dx Eval w/Med Serv 90792	Medicine	90792	CPT	2388418		Washington Regional Medical Center	outpatient	320	160	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	240	112.51	240
Psych Dx Eval w/Med Serv 90792	Psych Dx Eval w/Med Serv 90792	Medicine	90792	CPT	2388418		Washington Regional Medical Center	outpatient	320	160	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	140.8	112.51	240
Psych Dx Eval w/Med Serv 90792	Psych Dx Eval w/Med Serv 90792	Medicine	90792	CPT	2388418		Washington Regional Medical Center	outpatient	320	160	Humana	Medicare Advantage HMO/PPO/PFFS	150.4	112.51	240
Psych Dx Eval w/Med Serv 90792	Psych Dx Eval w/Med Serv 90792	Medicine	90792	CPT	2388418		Washington Regional Medical Center	outpatient	320	160	AmeriHealth Caritas North Carolina	NC Medicaid	112.51	112.51	240
Psych Dx Eval w/Med Serv 90792	Psych Dx Eval w/Med Serv 90792	Medicine	90792	CPT	2388418		Washington Regional Medical Center	outpatient	320	160	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	112.51	112.51	240
Psych Dx Eval w/Med Serv 90792	Psych Dx Eval w/Med Serv 90792	Medicine	90792	CPT	2388418		Washington Regional Medical Center	outpatient	320	160	WellCare of North Carolina	North Carolina Medicaid/CHIP	112.51	112.51	240
Psych Dx Eval w/Med Serv 90792	Psych Dx Eval w/Med Serv 90792	Medicine	90792	CPT	2388418		Washington Regional Medical Center	outpatient	320	160	Healthy Blue / Blue Cross NC	North Carolina Medicaid	112.51	112.51	240
Psych Dx Eval w/Med Serv 90792	Psych Dx Eval w/Med Serv 90792	Medicine	90792	CPT	2388418		Washington Regional Medical Center	outpatient	320	160	Cigna	North Carolina PPO-PPA Direct	144.84	112.51	240
Psych Dx Eval w/Med Serv 90792	Psych Dx Eval w/Med Serv 90792	Medicine	90792	CPT	2388418		Washington Regional Medical Center	outpatient	320	160	Original Medicare	Traditional Medicare Fee-for-Service	150.4	112.51	240
PT EVAL/VISIT MODERATE	PT EVAL/VISIT MODERATE	Medicine	97162	CPT	4101107		Washington Regional Medical Center	outpatient	304	152	Self-Pay	Discounted Cash		69.92	228
PT EVAL/VISIT MODERATE	PT EVAL/VISIT MODERATE	Medicine	97162	CPT	4101107		Washington Regional Medical Center	outpatient	304	152	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	228	69.92	228
PT EVAL/VISIT MODERATE	PT EVAL/VISIT MODERATE	Medicine	97162	CPT	4101107		Washington Regional Medical Center	outpatient	304	152	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	133.76	69.92	228
PT EVAL/VISIT MODERATE	PT EVAL/VISIT MODERATE	Medicine	97162	CPT	4101107		Washington Regional Medical Center	outpatient	304	152	Humana	Medicare Advantage HMO/PPO/PFFS	142.88	69.92	228
PT EVAL/VISIT MODERATE	PT EVAL/VISIT MODERATE	Medicine	97162	CPT	4101107		Washington Regional Medical Center	outpatient	304	152	AmeriHealth Caritas North Carolina	NC Medicaid	106.89	69.92	228
PT EVAL/VISIT MODERATE	PT EVAL/VISIT MODERATE	Medicine	97162	CPT	4101107		Washington Regional Medical Center	outpatient	304	152	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	106.89	69.92	228
PT EVAL/VISIT MODERATE	PT EVAL/VISIT MODERATE	Medicine	97162	CPT	4101107		Washington Regional Medical Center	outpatient	304	152	WellCare of North Carolina	North Carolina Medicaid/CHIP	106.89	69.92	228
PT EVAL/VISIT MODERATE	PT EVAL/VISIT MODERATE	Medicine	97162	CPT	4101107		Washington Regional Medical Center	outpatient	304	152	Healthy Blue / Blue Cross NC	North Carolina Medicaid	106.89	69.92	228
PT EVAL/VISIT MODERATE	PT EVAL/VISIT MODERATE	Medicine	97162	CPT	4101107		Washington Regional Medical Center	outpatient	304	152	Cigna	North Carolina PPO-PPA Direct	69.92	69.92	228
PT EVAL/VISIT MODERATE	PT EVAL/VISIT MODERATE	Medicine	97162	CPT	4101107		Washington Regional Medical Center	outpatient	304	152	Original Medicare	Traditional Medicare Fee-for-Service	142.88	69.92	228
PT IONTOPHORESIS/15 MIN	PT IONTOPHORESIS/15 MIN	Medicine	97033	CPT	4101009		Washington Regional Medical Center	outpatient	140	70	Self-Pay	Discounted Cash		16.63	105
PT IONTOPHORESIS/15 MIN	PT IONTOPHORESIS/15 MIN	Medicine	97033	CPT	4101009		Washington Regional Medical Center	outpatient	140	70	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	105	16.63	105
PT IONTOPHORESIS/15 MIN	PT IONTOPHORESIS/15 MIN	Medicine	97033	CPT	4101009		Washington Regional Medical Center	outpatient	140	70	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	61.6	16.63	105
PT IONTOPHORESIS/15 MIN	PT IONTOPHORESIS/15 MIN	Medicine	97033	CPT	4101009		Washington Regional Medical Center	outpatient	140	70	Humana	Medicare Advantage HMO/PPO/PFFS	65.8	16.63	105
PT IONTOPHORESIS/15 MIN	PT IONTOPHORESIS/15 MIN	Medicine	97033	CPT	4101009		Washington Regional Medical Center	outpatient	140	70	AmeriHealth Caritas North Carolina	NC Medicaid	49.22	16.63	105
PT IONTOPHORESIS/15 MIN	PT IONTOPHORESIS/15 MIN	Medicine	97033	CPT	4101009		Washington Regional Medical Center	outpatient	140	70	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	49.22	16.63	105
PT IONTOPHORESIS/15 MIN	PT IONTOPHORESIS/15 MIN	Medicine	97033	CPT	4101009		Washington Regional Medical Center	outpatient	140	70	WellCare of North Carolina	North Carolina Medicaid/CHIP	49.22	16.63	105
PT IONTOPHORESIS/15 MIN	PT IONTOPHORESIS/15 MIN	Medicine	97033	CPT	4101009		Washington Regional Medical Center	outpatient	140	70	Healthy Blue / Blue Cross NC	North Carolina Medicaid	49.22	16.63	105
PT IONTOPHORESIS/15 MIN	PT IONTOPHORESIS/15 MIN	Medicine	97033	CPT	4101009		Washington Regional Medical Center	outpatient	140	70	Cigna	North Carolina PPO-PPA Direct	16.63	16.63	105
PT IONTOPHORESIS/15 MIN	PT IONTOPHORESIS/15 MIN	Medicine	97033	CPT	4101009		Washington Regional Medical Center	outpatient	140	70	Original Medicare	Traditional Medicare Fee-for-Service	65.8	16.63	105
PT MECH TRACTION/VISIT	PT MECH TRACTION/VISIT	Medicine	97012	CPT	4101012		Washington Regional Medical Center	outpatient	99	49.5	Self-Pay	Discounted Cash		12.13	74.25
PT MECH TRACTION/VISIT	PT MECH TRACTION/VISIT	Medicine	97012	CPT	4101012		Washington Regional Medical Center	outpatient	99	49.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	74.25	12.13	74.25
PT MECH TRACTION/VISIT	PT MECH TRACTION/VISIT	Medicine	97012	CPT	4101012		Washington Regional Medical Center	outpatient	99	49.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	43.56	12.13	74.25
PT MECH TRACTION/VISIT	PT MECH TRACTION/VISIT	Medicine	97012	CPT	4101012		Washington Regional Medical Center	outpatient	99	49.5	Humana	Medicare Advantage HMO/PPO/PFFS	46.53	12.13	74.25
PT MECH TRACTION/VISIT	PT MECH TRACTION/VISIT	Medicine	97012	CPT	4101012		Washington Regional Medical Center	outpatient	99	49.5	AmeriHealth Caritas North Carolina	NC Medicaid	34.81	12.13	74.25
PT MECH TRACTION/VISIT	PT MECH TRACTION/VISIT	Medicine	97012	CPT	4101012		Washington Regional Medical Center	outpatient	99	49.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	34.81	12.13	74.25
PT MECH TRACTION/VISIT	PT MECH TRACTION/VISIT	Medicine	97012	CPT	4101012		Washington Regional Medical Center	outpatient	99	49.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	34.81	12.13	74.25
PT MECH TRACTION/VISIT	PT MECH TRACTION/VISIT	Medicine	97012	CPT	4101012		Washington Regional Medical Center	outpatient	99	49.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	34.81	12.13	74.25
PT MECH TRACTION/VISIT	PT MECH TRACTION/VISIT	Medicine	97012	CPT	4101012		Washington Regional Medical Center	outpatient	99	49.5	Cigna	North Carolina PPO-PPA Direct	12.13	12.13	74.25
PT MECH TRACTION/VISIT	PT MECH TRACTION/VISIT	Medicine	97012	CPT	4101012		Washington Regional Medical Center	outpatient	99	49.5	Original Medicare	Traditional Medicare Fee-for-Service	46.53	12.13	74.25
PT NEURO RE-ED/15 MIN	PT NEURO RE-ED/15 MIN	Medicine	97112	CPT	4101014		Washington Regional Medical Center	outpatient	146	73	Self-Pay	Discounted Cash		24.15	109.5
PT NEURO RE-ED/15 MIN	PT NEURO RE-ED/15 MIN	Medicine	97112	CPT	4101014		Washington Regional Medical Center	outpatient	146	73	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	109.5	24.15	109.5
PT NEURO RE-ED/15 MIN	PT NEURO RE-ED/15 MIN	Medicine	97112	CPT	4101014		Washington Regional Medical Center	outpatient	146	73	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	64.24	24.15	109.5
PT NEURO RE-ED/15 MIN	PT NEURO RE-ED/15 MIN	Medicine	97112	CPT	4101014		Washington Regional Medical Center	outpatient	146	73	Humana	Medicare Advantage HMO/PPO/PFFS	68.62	24.15	109.5
PT NEURO RE-ED/15 MIN	PT NEURO RE-ED/15 MIN	Medicine	97112	CPT	4101014		Washington Regional Medical Center	outpatient	146	73	AmeriHealth Caritas North Carolina	NC Medicaid	51.33	24.15	109.5
PT NEURO RE-ED/15 MIN	PT NEURO RE-ED/15 MIN	Medicine	97112	CPT	4101014		Washington Regional Medical Center	outpatient	146	73	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	51.33	24.15	109.5
PT NEURO RE-ED/15 MIN	PT NEURO RE-ED/15 MIN	Medicine	97112	CPT	4101014		Washington Regional Medical Center	outpatient	146	73	WellCare of North Carolina	North Carolina Medicaid/CHIP	51.33	24.15	109.5
PT NEURO RE-ED/15 MIN	PT NEURO RE-ED/15 MIN	Medicine	97112	CPT	4101014		Washington Regional Medical Center	outpatient	146	73	Healthy Blue / Blue Cross NC	North Carolina Medicaid	51.33	24.15	109.5
PT NEURO RE-ED/15 MIN	PT NEURO RE-ED/15 MIN	Medicine	97112	CPT	4101014		Washington Regional Medical Center	outpatient	146	73	Cigna	North Carolina PPO-PPA Direct	24.15	24.15	109.5
PT NEURO RE-ED/15 MIN	PT NEURO RE-ED/15 MIN	Medicine	97112	CPT	4101014		Washington Regional Medical Center	outpatient	146	73	Original Medicare	Traditional Medicare Fee-for-Service	68.62	24.15	109.5
PT PHYS PERFORMANCE TEST/15MIN	PT PHYS PERFORMANCE TEST/15MIN	Medicine	97750	CPT	4101041		Washington Regional Medical Center	outpatient	143	71.5	Self-Pay	Discounted Cash		24.44	107.25
PT PHYS PERFORMANCE TEST/15MIN	PT PHYS PERFORMANCE TEST/15MIN	Medicine	97750	CPT	4101041		Washington Regional Medical Center	outpatient	143	71.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	107.25	24.44	107.25
PT PHYS PERFORMANCE TEST/15MIN	PT PHYS PERFORMANCE TEST/15MIN	Medicine	97750	CPT	4101041		Washington Regional Medical Center	outpatient	143	71.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	62.92	24.44	107.25
PT PHYS PERFORMANCE TEST/15MIN	PT PHYS PERFORMANCE TEST/15MIN	Medicine	97750	CPT	4101041		Washington Regional Medical Center	outpatient	143	71.5	Humana	Medicare Advantage HMO/PPO/PFFS	67.21	24.44	107.25
PT PHYS PERFORMANCE TEST/15MIN	PT PHYS PERFORMANCE TEST/15MIN	Medicine	97750	CPT	4101041		Washington Regional Medical Center	outpatient	143	71.5	AmeriHealth Caritas North Carolina	NC Medicaid	50.28	24.44	107.25
PT PHYS PERFORMANCE TEST/15MIN	PT PHYS PERFORMANCE TEST/15MIN	Medicine	97750	CPT	4101041		Washington Regional Medical Center	outpatient	143	71.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	50.28	24.44	107.25
PT PHYS PERFORMANCE TEST/15MIN	PT PHYS PERFORMANCE TEST/15MIN	Medicine	97750	CPT	4101041		Washington Regional Medical Center	outpatient	143	71.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	50.28	24.44	107.25
PT PHYS PERFORMANCE TEST/15MIN	PT PHYS PERFORMANCE TEST/15MIN	Medicine	97750	CPT	4101041		Washington Regional Medical Center	outpatient	143	71.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	50.28	24.44	107.25
PT PHYS PERFORMANCE TEST/15MIN	PT PHYS PERFORMANCE TEST/15MIN	Medicine	97750	CPT	4101041		Washington Regional Medical Center	outpatient	143	71.5	Cigna	North Carolina PPO-PPA Direct	24.44	24.44	107.25
PT PHYS PERFORMANCE TEST/15MIN	PT PHYS PERFORMANCE TEST/15MIN	Medicine	97750	CPT	4101041		Washington Regional Medical Center	outpatient	143	71.5	Original Medicare	Traditional Medicare Fee-for-Service	67.21	24.44	107.25
PT SELF CARE MGT/15 MIN	PT SELF CARE MGT/15 MIN	Medicine	97535	CPT	4101021		Washington Regional Medical Center	outpatient	105	52.5	Self-Pay	Discounted Cash		24.53	78.75
PT SELF CARE MGT/15 MIN	PT SELF CARE MGT/15 MIN	Medicine	97535	CPT	4101021		Washington Regional Medical Center	outpatient	105	52.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	78.75	24.53	78.75
PT SELF CARE MGT/15 MIN	PT SELF CARE MGT/15 MIN	Medicine	97535	CPT	4101021		Washington Regional Medical Center	outpatient	105	52.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	46.2	24.53	78.75
PT SELF CARE MGT/15 MIN	PT SELF CARE MGT/15 MIN	Medicine	97535	CPT	4101021		Washington Regional Medical Center	outpatient	105	52.5	Humana	Medicare Advantage HMO/PPO/PFFS	49.35	24.53	78.75
PT SELF CARE MGT/15 MIN	PT SELF CARE MGT/15 MIN	Medicine	97535	CPT	4101021		Washington Regional Medical Center	outpatient	105	52.5	AmeriHealth Caritas North Carolina	NC Medicaid	36.92	24.53	78.75
PT SELF CARE MGT/15 MIN	PT SELF CARE MGT/15 MIN	Medicine	97535	CPT	4101021		Washington Regional Medical Center	outpatient	105	52.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	36.92	24.53	78.75
PT SELF CARE MGT/15 MIN	PT SELF CARE MGT/15 MIN	Medicine	97535	CPT	4101021		Washington Regional Medical Center	outpatient	105	52.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	36.92	24.53	78.75
PT SELF CARE MGT/15 MIN	PT SELF CARE MGT/15 MIN	Medicine	97535	CPT	4101021		Washington Regional Medical Center	outpatient	105	52.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	36.92	24.53	78.75
PT SELF CARE MGT/15 MIN	PT SELF CARE MGT/15 MIN	Medicine	97535	CPT	4101021		Washington Regional Medical Center	outpatient	105	52.5	Cigna	North Carolina PPO-PPA Direct	24.53	24.53	78.75
PT SELF CARE MGT/15 MIN	PT SELF CARE MGT/15 MIN	Medicine	97535	CPT	4101021		Washington Regional Medical Center	outpatient	105	52.5	Original Medicare	Traditional Medicare Fee-for-Service	49.35	24.53	78.75
PT THER ACTS 1 ON 1/15 MIN	PT THER ACTS 1 ON 1/15 MIN	Medicine	97530	CPT	4101022		Washington Regional Medical Center	outpatient	140	70	Self-Pay	Discounted Cash		24.12	105
PT THER ACTS 1 ON 1/15 MIN	PT THER ACTS 1 ON 1/15 MIN	Medicine	97530	CPT	4101022		Washington Regional Medical Center	outpatient	140	70	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	105	24.12	105
PT THER ACTS 1 ON 1/15 MIN	PT THER ACTS 1 ON 1/15 MIN	Medicine	97530	CPT	4101022		Washington Regional Medical Center	outpatient	140	70	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	61.6	24.12	105
PT THER ACTS 1 ON 1/15 MIN	PT THER ACTS 1 ON 1/15 MIN	Medicine	97530	CPT	4101022		Washington Regional Medical Center	outpatient	140	70	Humana	Medicare Advantage HMO/PPO/PFFS	65.8	24.12	105
PT THER ACTS 1 ON 1/15 MIN	PT THER ACTS 1 ON 1/15 MIN	Medicine	97530	CPT	4101022		Washington Regional Medical Center	outpatient	140	70	AmeriHealth Caritas North Carolina	NC Medicaid	49.22	24.12	105
PT THER ACTS 1 ON 1/15 MIN	PT THER ACTS 1 ON 1/15 MIN	Medicine	97530	CPT	4101022		Washington Regional Medical Center	outpatient	140	70	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	49.22	24.12	105
PT THER ACTS 1 ON 1/15 MIN	PT THER ACTS 1 ON 1/15 MIN	Medicine	97530	CPT	4101022		Washington Regional Medical Center	outpatient	140	70	WellCare of North Carolina	North Carolina Medicaid/CHIP	49.22	24.12	105
PT THER ACTS 1 ON 1/15 MIN	PT THER ACTS 1 ON 1/15 MIN	Medicine	97530	CPT	4101022		Washington Regional Medical Center	outpatient	140	70	Healthy Blue / Blue Cross NC	North Carolina Medicaid	49.22	24.12	105
PT THER ACTS 1 ON 1/15 MIN	PT THER ACTS 1 ON 1/15 MIN	Medicine	97530	CPT	4101022		Washington Regional Medical Center	outpatient	140	70	Cigna	North Carolina PPO-PPA Direct	24.12	24.12	105
PT THER ACTS 1 ON 1/15 MIN	PT THER ACTS 1 ON 1/15 MIN	Medicine	97530	CPT	4101022		Washington Regional Medical Center	outpatient	140	70	Original Medicare	Traditional Medicare Fee-for-Service	65.8	24.12	105
PT VASPNEUMATIC DEV/VIS	PT VASPNEUMATIC DEV/VIS	Medicine	97016	CPT	4101026		Washington Regional Medical Center	outpatient	60	30	Self-Pay	Discounted Cash		11.37	45
PT VASPNEUMATIC DEV/VIS	PT VASPNEUMATIC DEV/VIS	Medicine	97016	CPT	4101026		Washington Regional Medical Center	outpatient	60	30	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	45	11.37	45
PT VASPNEUMATIC DEV/VIS	PT VASPNEUMATIC DEV/VIS	Medicine	97016	CPT	4101026		Washington Regional Medical Center	outpatient	60	30	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	26.4	11.37	45
PT VASPNEUMATIC DEV/VIS	PT VASPNEUMATIC DEV/VIS	Medicine	97016	CPT	4101026		Washington Regional Medical Center	outpatient	60	30	Humana	Medicare Advantage HMO/PPO/PFFS	28.2	11.37	45
PT VASPNEUMATIC DEV/VIS	PT VASPNEUMATIC DEV/VIS	Medicine	97016	CPT	4101026		Washington Regional Medical Center	outpatient	60	30	AmeriHealth Caritas North Carolina	NC Medicaid	21.1	11.37	45
PT VASPNEUMATIC DEV/VIS	PT VASPNEUMATIC DEV/VIS	Medicine	97016	CPT	4101026		Washington Regional Medical Center	outpatient	60	30	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	21.1	11.37	45
PT VASPNEUMATIC DEV/VIS	PT VASPNEUMATIC DEV/VIS	Medicine	97016	CPT	4101026		Washington Regional Medical Center	outpatient	60	30	WellCare of North Carolina	North Carolina Medicaid/CHIP	21.1	11.37	45
PT VASPNEUMATIC DEV/VIS	PT VASPNEUMATIC DEV/VIS	Medicine	97016	CPT	4101026		Washington Regional Medical Center	outpatient	60	30	Healthy Blue / Blue Cross NC	North Carolina Medicaid	21.1	11.37	45
PT VASPNEUMATIC DEV/VIS	PT VASPNEUMATIC DEV/VIS	Medicine	97016	CPT	4101026		Washington Regional Medical Center	outpatient	60	30	Cigna	North Carolina PPO-PPA Direct	11.37	11.37	45
PT VASPNEUMATIC DEV/VIS	PT VASPNEUMATIC DEV/VIS	Medicine	97016	CPT	4101026		Washington Regional Medical Center	outpatient	60	30	Original Medicare	Traditional Medicare Fee-for-Service	28.2	11.37	45
PT WORK HARDEN/COND 1ST 2HR	PT WORK HARDEN/COND 1ST 2HR	Medicine	97545	CPT	4101048		Washington Regional Medical Center	outpatient	163	81.5	Self-Pay	Discounted Cash		57.31	122.25
PT WORK HARDEN/COND 1ST 2HR	PT WORK HARDEN/COND 1ST 2HR	Medicine	97545	CPT	4101048		Washington Regional Medical Center	outpatient	163	81.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	122.25	57.31	122.25
PT WORK HARDEN/COND 1ST 2HR	PT WORK HARDEN/COND 1ST 2HR	Medicine	97545	CPT	4101048		Washington Regional Medical Center	outpatient	163	81.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	71.72	57.31	122.25
PT WORK HARDEN/COND 1ST 2HR	PT WORK HARDEN/COND 1ST 2HR	Medicine	97545	CPT	4101048		Washington Regional Medical Center	outpatient	163	81.5	Humana	Medicare Advantage HMO/PPO/PFFS	76.61	57.31	122.25
PT WORK HARDEN/COND 1ST 2HR	PT WORK HARDEN/COND 1ST 2HR	Medicine	97545	CPT	4101048		Washington Regional Medical Center	outpatient	163	81.5	AmeriHealth Caritas North Carolina	NC Medicaid	57.31	57.31	122.25
PT WORK HARDEN/COND 1ST 2HR	PT WORK HARDEN/COND 1ST 2HR	Medicine	97545	CPT	4101048		Washington Regional Medical Center	outpatient	163	81.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	57.31	57.31	122.25
PT WORK HARDEN/COND 1ST 2HR	PT WORK HARDEN/COND 1ST 2HR	Medicine	97545	CPT	4101048		Washington Regional Medical Center	outpatient	163	81.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	57.31	57.31	122.25
PT WORK HARDEN/COND 1ST 2HR	PT WORK HARDEN/COND 1ST 2HR	Medicine	97545	CPT	4101048		Washington Regional Medical Center	outpatient	163	81.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	57.31	57.31	122.25
PT WORK HARDEN/COND 1ST 2HR	PT WORK HARDEN/COND 1ST 2HR	Medicine	97545	CPT	4101048		Washington Regional Medical Center	outpatient	163	81.5	Cigna	North Carolina PPO-PPA Direct	96.76	57.31	122.25
PT WORK HARDEN/COND 1ST 2HR	PT WORK HARDEN/COND 1ST 2HR	Medicine	97545	CPT	4101048		Washington Regional Medical Center	outpatient	163	81.5	Original Medicare	Traditional Medicare Fee-for-Service	76.61	57.31	122.25
PT/OT TELE SELF CARE	PT/OT TELE SELF CARE	Medicine	97535	CPT	7809307		Washington Regional Medical Center	outpatient	90	45	Self-Pay	Discounted Cash		24.53	67.5
PT/OT TELE SELF CARE	PT/OT TELE SELF CARE	Medicine	97535	CPT	7809307		Washington Regional Medical Center	outpatient	90	45	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	67.5	24.53	67.5
PT/OT TELE SELF CARE	PT/OT TELE SELF CARE	Medicine	97535	CPT	7809307		Washington Regional Medical Center	outpatient	90	45	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	39.6	24.53	67.5
PT/OT TELE SELF CARE	PT/OT TELE SELF CARE	Medicine	97535	CPT	7809307		Washington Regional Medical Center	outpatient	90	45	Humana	Medicare Advantage HMO/PPO/PFFS	42.3	24.53	67.5
PT/OT TELE SELF CARE	PT/OT TELE SELF CARE	Medicine	97535	CPT	7809307		Washington Regional Medical Center	outpatient	90	45	AmeriHealth Caritas North Carolina	NC Medicaid	31.64	24.53	67.5
PT/OT TELE SELF CARE	PT/OT TELE SELF CARE	Medicine	97535	CPT	7809307		Washington Regional Medical Center	outpatient	90	45	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	31.64	24.53	67.5
PT/OT TELE SELF CARE	PT/OT TELE SELF CARE	Medicine	97535	CPT	7809307		Washington Regional Medical Center	outpatient	90	45	WellCare of North Carolina	North Carolina Medicaid/CHIP	31.64	24.53	67.5
PT/OT TELE SELF CARE	PT/OT TELE SELF CARE	Medicine	97535	CPT	7809307		Washington Regional Medical Center	outpatient	90	45	Healthy Blue / Blue Cross NC	North Carolina Medicaid	31.64	24.53	67.5
PT/OT TELE SELF CARE	PT/OT TELE SELF CARE	Medicine	97535	CPT	7809307		Washington Regional Medical Center	outpatient	90	45	Cigna	North Carolina PPO-PPA Direct	24.53	24.53	67.5
PT/OT TELE SELF CARE	PT/OT TELE SELF CARE	Medicine	97535	CPT	7809307		Washington Regional Medical Center	outpatient	90	45	Original Medicare	Traditional Medicare Fee-for-Service	42.3	24.53	67.5
PT/OT TELE THER ACT	PT/OT TELE THER ACT	Medicine	97530	CPT	7809308		Washington Regional Medical Center	outpatient	140	70	Self-Pay	Discounted Cash		24.12	105
PT/OT TELE THER ACT	PT/OT TELE THER ACT	Medicine	97530	CPT	7809308		Washington Regional Medical Center	outpatient	140	70	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	105	24.12	105
PT/OT TELE THER ACT	PT/OT TELE THER ACT	Medicine	97530	CPT	7809308		Washington Regional Medical Center	outpatient	140	70	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	61.6	24.12	105
PT/OT TELE THER ACT	PT/OT TELE THER ACT	Medicine	97530	CPT	7809308		Washington Regional Medical Center	outpatient	140	70	Humana	Medicare Advantage HMO/PPO/PFFS	65.8	24.12	105
PT/OT TELE THER ACT	PT/OT TELE THER ACT	Medicine	97530	CPT	7809308		Washington Regional Medical Center	outpatient	140	70	AmeriHealth Caritas North Carolina	NC Medicaid	49.22	24.12	105
PT/OT TELE THER ACT	PT/OT TELE THER ACT	Medicine	97530	CPT	7809308		Washington Regional Medical Center	outpatient	140	70	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	49.22	24.12	105
PT/OT TELE THER ACT	PT/OT TELE THER ACT	Medicine	97530	CPT	7809308		Washington Regional Medical Center	outpatient	140	70	WellCare of North Carolina	North Carolina Medicaid/CHIP	49.22	24.12	105
PT/OT TELE THER ACT	PT/OT TELE THER ACT	Medicine	97530	CPT	7809308		Washington Regional Medical Center	outpatient	140	70	Healthy Blue / Blue Cross NC	North Carolina Medicaid	49.22	24.12	105
PT/OT TELE THER ACT	PT/OT TELE THER ACT	Medicine	97530	CPT	7809308		Washington Regional Medical Center	outpatient	140	70	Cigna	North Carolina PPO-PPA Direct	24.12	24.12	105
PT/OT TELE THER ACT	PT/OT TELE THER ACT	Medicine	97530	CPT	7809308		Washington Regional Medical Center	outpatient	140	70	Original Medicare	Traditional Medicare Fee-for-Service	65.8	24.12	105
PULMONARY STRESS TEST	PULMONARY STRESS TEST	Medicine	94618	CPT	4001199		Washington Regional Medical Center	outpatient	460.64	230.32	Self-Pay	Discounted Cash		12.22	345.48
PULMONARY STRESS TEST	PULMONARY STRESS TEST	Medicine	94618	CPT	4001199		Washington Regional Medical Center	outpatient	460.64	230.32	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	345.48	12.22	345.48
PULMONARY STRESS TEST	PULMONARY STRESS TEST	Medicine	94618	CPT	4001199		Washington Regional Medical Center	outpatient	460.64	230.32	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	202.68	12.22	345.48
PULMONARY STRESS TEST	PULMONARY STRESS TEST	Medicine	94618	CPT	4001199		Washington Regional Medical Center	outpatient	460.64	230.32	Humana	Medicare Advantage HMO/PPO/PFFS	216.5	12.22	345.48
PULMONARY STRESS TEST	PULMONARY STRESS TEST	Medicine	94618	CPT	4001199		Washington Regional Medical Center	outpatient	460.64	230.32	AmeriHealth Caritas North Carolina	NC Medicaid	161.96	12.22	345.48
PULMONARY STRESS TEST	PULMONARY STRESS TEST	Medicine	94618	CPT	4001199		Washington Regional Medical Center	outpatient	460.64	230.32	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	161.96	12.22	345.48
PULMONARY STRESS TEST	PULMONARY STRESS TEST	Medicine	94618	CPT	4001199		Washington Regional Medical Center	outpatient	460.64	230.32	WellCare of North Carolina	North Carolina Medicaid/CHIP	161.96	12.22	345.48
PULMONARY STRESS TEST	PULMONARY STRESS TEST	Medicine	94618	CPT	4001199		Washington Regional Medical Center	outpatient	460.64	230.32	Healthy Blue / Blue Cross NC	North Carolina Medicaid	161.96	12.22	345.48
PULMONARY STRESS TEST	PULMONARY STRESS TEST	Medicine	94618	CPT	4001199		Washington Regional Medical Center	outpatient	460.64	230.32	Cigna	North Carolina PPO-PPA Direct	12.22	12.22	345.48
PULMONARY STRESS TEST	PULMONARY STRESS TEST	Medicine	94618	CPT	4001199		Washington Regional Medical Center	outpatient	460.64	230.32	Original Medicare	Traditional Medicare Fee-for-Service	216.5	12.22	345.48
Rho(d) Imm Glbln F-D Im 90384	Rho(d) Imm Glbln F-D Im 90384	Medicine	90384	CPT	2388322		Washington Regional Medical Center	outpatient	620	310	Self-Pay	Discounted Cash		92.77	465
Rho(d) Imm Glbln F-D Im 90384	Rho(d) Imm Glbln F-D Im 90384	Medicine	90384	CPT	2388322		Washington Regional Medical Center	outpatient	620	310	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	465	92.77	465
Rho(d) Imm Glbln F-D Im 90384	Rho(d) Imm Glbln F-D Im 90384	Medicine	90384	CPT	2388322		Washington Regional Medical Center	outpatient	620	310	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	272.8	92.77	465
Rho(d) Imm Glbln F-D Im 90384	Rho(d) Imm Glbln F-D Im 90384	Medicine	90384	CPT	2388322		Washington Regional Medical Center	outpatient	620	310	Humana	Medicare Advantage HMO/PPO/PFFS	291.4	92.77	465
Rho(d) Imm Glbln F-D Im 90384	Rho(d) Imm Glbln F-D Im 90384	Medicine	90384	CPT	2388322		Washington Regional Medical Center	outpatient	620	310	AmeriHealth Caritas North Carolina	NC Medicaid	217.99	92.77	465
Rho(d) Imm Glbln F-D Im 90384	Rho(d) Imm Glbln F-D Im 90384	Medicine	90384	CPT	2388322		Washington Regional Medical Center	outpatient	620	310	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	217.99	92.77	465
Rho(d) Imm Glbln F-D Im 90384	Rho(d) Imm Glbln F-D Im 90384	Medicine	90384	CPT	2388322		Washington Regional Medical Center	outpatient	620	310	WellCare of North Carolina	North Carolina Medicaid/CHIP	217.99	92.77	465
Rho(d) Imm Glbln F-D Im 90384	Rho(d) Imm Glbln F-D Im 90384	Medicine	90384	CPT	2388322		Washington Regional Medical Center	outpatient	620	310	Healthy Blue / Blue Cross NC	North Carolina Medicaid	217.99	92.77	465
Rho(d) Imm Glbln F-D Im 90384	Rho(d) Imm Glbln F-D Im 90384	Medicine	90384	CPT	2388322		Washington Regional Medical Center	outpatient	620	310	Cigna	North Carolina PPO-PPA Direct	92.77	92.77	465
Rho(d) Imm Glbln F-D Im 90384	Rho(d) Imm Glbln F-D Im 90384	Medicine	90384	CPT	2388322		Washington Regional Medical Center	outpatient	620	310	Original Medicare	Traditional Medicare Fee-for-Service	291.4	92.77	465
RT ArslTx InhPentamidine 94642	RT ArslTx InhPentamidine 94642	Medicine	94642	CPT	7880372		Washington Regional Medical Center	outpatient	767.88	383.94	Self-Pay	Discounted Cash		61.44	575.91
RT ArslTx InhPentamidine 94642	RT ArslTx InhPentamidine 94642	Medicine	94642	CPT	7880372		Washington Regional Medical Center	outpatient	767.88	383.94	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	575.91	61.44	575.91
RT ArslTx InhPentamidine 94642	RT ArslTx InhPentamidine 94642	Medicine	94642	CPT	7880372		Washington Regional Medical Center	outpatient	767.88	383.94	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	337.87	61.44	575.91
RT ArslTx InhPentamidine 94642	RT ArslTx InhPentamidine 94642	Medicine	94642	CPT	7880372		Washington Regional Medical Center	outpatient	767.88	383.94	Humana	Medicare Advantage HMO/PPO/PFFS	360.9	61.44	575.91
RT ArslTx InhPentamidine 94642	RT ArslTx InhPentamidine 94642	Medicine	94642	CPT	7880372		Washington Regional Medical Center	outpatient	767.88	383.94	AmeriHealth Caritas North Carolina	NC Medicaid	269.99	61.44	575.91
RT ArslTx InhPentamidine 94642	RT ArslTx InhPentamidine 94642	Medicine	94642	CPT	7880372		Washington Regional Medical Center	outpatient	767.88	383.94	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	269.99	61.44	575.91
RT ArslTx InhPentamidine 94642	RT ArslTx InhPentamidine 94642	Medicine	94642	CPT	7880372		Washington Regional Medical Center	outpatient	767.88	383.94	WellCare of North Carolina	North Carolina Medicaid/CHIP	269.99	61.44	575.91
RT ArslTx InhPentamidine 94642	RT ArslTx InhPentamidine 94642	Medicine	94642	CPT	7880372		Washington Regional Medical Center	outpatient	767.88	383.94	Healthy Blue / Blue Cross NC	North Carolina Medicaid	269.99	61.44	575.91
RT ArslTx InhPentamidine 94642	RT ArslTx InhPentamidine 94642	Medicine	94642	CPT	7880372		Washington Regional Medical Center	outpatient	767.88	383.94	Cigna	North Carolina PPO-PPA Direct	61.44	61.44	575.91
RT ArslTx InhPentamidine 94642	RT ArslTx InhPentamidine 94642	Medicine	94642	CPT	7880372		Washington Regional Medical Center	outpatient	767.88	383.94	Original Medicare	Traditional Medicare Fee-for-Service	360.9	61.44	575.91
RT Charge 6 Minute Walk	RT Charge 6 Minute Walk	Medicine	94618	CPT	5488822		Washington Regional Medical Center	outpatient	460.64	230.32	Self-Pay	Discounted Cash		12.22	345.48
RT Charge 6 Minute Walk	RT Charge 6 Minute Walk	Medicine	94618	CPT	5488822		Washington Regional Medical Center	outpatient	460.64	230.32	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	345.48	12.22	345.48
RT Charge 6 Minute Walk	RT Charge 6 Minute Walk	Medicine	94618	CPT	5488822		Washington Regional Medical Center	outpatient	460.64	230.32	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	202.68	12.22	345.48
RT Charge 6 Minute Walk	RT Charge 6 Minute Walk	Medicine	94618	CPT	5488822		Washington Regional Medical Center	outpatient	460.64	230.32	Humana	Medicare Advantage HMO/PPO/PFFS	216.5	12.22	345.48
RT Charge 6 Minute Walk	RT Charge 6 Minute Walk	Medicine	94618	CPT	5488822		Washington Regional Medical Center	outpatient	460.64	230.32	AmeriHealth Caritas North Carolina	NC Medicaid	161.96	12.22	345.48
RT Charge 6 Minute Walk	RT Charge 6 Minute Walk	Medicine	94618	CPT	5488822		Washington Regional Medical Center	outpatient	460.64	230.32	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	161.96	12.22	345.48
RT Charge 6 Minute Walk	RT Charge 6 Minute Walk	Medicine	94618	CPT	5488822		Washington Regional Medical Center	outpatient	460.64	230.32	WellCare of North Carolina	North Carolina Medicaid/CHIP	161.96	12.22	345.48
RT Charge 6 Minute Walk	RT Charge 6 Minute Walk	Medicine	94618	CPT	5488822		Washington Regional Medical Center	outpatient	460.64	230.32	Healthy Blue / Blue Cross NC	North Carolina Medicaid	161.96	12.22	345.48
RT Charge 6 Minute Walk	RT Charge 6 Minute Walk	Medicine	94618	CPT	5488822		Washington Regional Medical Center	outpatient	460.64	230.32	Cigna	North Carolina PPO-PPA Direct	12.22	12.22	345.48
RT Charge 6 Minute Walk	RT Charge 6 Minute Walk	Medicine	94618	CPT	5488822		Washington Regional Medical Center	outpatient	460.64	230.32	Original Medicare	Traditional Medicare Fee-for-Service	216.5	12.22	345.48
RT CHARGE Chest PT Subseq	RT CHARGE Chest PT Subseq	Medicine	94668	CPT	6690678		Washington Regional Medical Center	outpatient	460.64	230.32	Self-Pay	Discounted Cash		17.89	345.48
RT CHARGE Chest PT Subseq	RT CHARGE Chest PT Subseq	Medicine	94668	CPT	6690678		Washington Regional Medical Center	outpatient	460.64	230.32	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	345.48	17.89	345.48
RT CHARGE Chest PT Subseq	RT CHARGE Chest PT Subseq	Medicine	94668	CPT	6690678		Washington Regional Medical Center	outpatient	460.64	230.32	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	202.68	17.89	345.48
RT CHARGE Chest PT Subseq	RT CHARGE Chest PT Subseq	Medicine	94668	CPT	6690678		Washington Regional Medical Center	outpatient	460.64	230.32	Humana	Medicare Advantage HMO/PPO/PFFS	216.5	17.89	345.48
RT CHARGE Chest PT Subseq	RT CHARGE Chest PT Subseq	Medicine	94668	CPT	6690678		Washington Regional Medical Center	outpatient	460.64	230.32	AmeriHealth Caritas North Carolina	NC Medicaid	161.96	17.89	345.48
RT CHARGE Chest PT Subseq	RT CHARGE Chest PT Subseq	Medicine	94668	CPT	6690678		Washington Regional Medical Center	outpatient	460.64	230.32	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	161.96	17.89	345.48
RT CHARGE Chest PT Subseq	RT CHARGE Chest PT Subseq	Medicine	94668	CPT	6690678		Washington Regional Medical Center	outpatient	460.64	230.32	WellCare of North Carolina	North Carolina Medicaid/CHIP	161.96	17.89	345.48
RT CHARGE Chest PT Subseq	RT CHARGE Chest PT Subseq	Medicine	94668	CPT	6690678		Washington Regional Medical Center	outpatient	460.64	230.32	Healthy Blue / Blue Cross NC	North Carolina Medicaid	161.96	17.89	345.48
RT CHARGE Chest PT Subseq	RT CHARGE Chest PT Subseq	Medicine	94668	CPT	6690678		Washington Regional Medical Center	outpatient	460.64	230.32	Cigna	North Carolina PPO-PPA Direct	17.89	17.89	345.48
RT CHARGE Chest PT Subseq	RT CHARGE Chest PT Subseq	Medicine	94668	CPT	6690678		Washington Regional Medical Center	outpatient	460.64	230.32	Original Medicare	Traditional Medicare Fee-for-Service	216.5	17.89	345.48
RT Lung Nitrogen Washout 94727	RT Lung Nitrogen Washout 94727	Medicine	94727	CPT	8019395		Washington Regional Medical Center	outpatient	570.36	285.18	Self-Pay	Discounted Cash		33.81	427.77
RT Lung Nitrogen Washout 94727	RT Lung Nitrogen Washout 94727	Medicine	94727	CPT	8019395		Washington Regional Medical Center	outpatient	570.36	285.18	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	427.77	33.81	427.77
RT Lung Nitrogen Washout 94727	RT Lung Nitrogen Washout 94727	Medicine	94727	CPT	8019395		Washington Regional Medical Center	outpatient	570.36	285.18	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	250.96	33.81	427.77
RT Lung Nitrogen Washout 94727	RT Lung Nitrogen Washout 94727	Medicine	94727	CPT	8019395		Washington Regional Medical Center	outpatient	570.36	285.18	Humana	Medicare Advantage HMO/PPO/PFFS	268.07	33.81	427.77
RT Lung Nitrogen Washout 94727	RT Lung Nitrogen Washout 94727	Medicine	94727	CPT	8019395		Washington Regional Medical Center	outpatient	570.36	285.18	AmeriHealth Caritas North Carolina	NC Medicaid	200.54	33.81	427.77
RT Lung Nitrogen Washout 94727	RT Lung Nitrogen Washout 94727	Medicine	94727	CPT	8019395		Washington Regional Medical Center	outpatient	570.36	285.18	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	200.54	33.81	427.77
RT Lung Nitrogen Washout 94727	RT Lung Nitrogen Washout 94727	Medicine	94727	CPT	8019395		Washington Regional Medical Center	outpatient	570.36	285.18	WellCare of North Carolina	North Carolina Medicaid/CHIP	200.54	33.81	427.77
RT Lung Nitrogen Washout 94727	RT Lung Nitrogen Washout 94727	Medicine	94727	CPT	8019395		Washington Regional Medical Center	outpatient	570.36	285.18	Healthy Blue / Blue Cross NC	North Carolina Medicaid	200.54	33.81	427.77
RT Lung Nitrogen Washout 94727	RT Lung Nitrogen Washout 94727	Medicine	94727	CPT	8019395		Washington Regional Medical Center	outpatient	570.36	285.18	Cigna	North Carolina PPO-PPA Direct	33.81	33.81	427.77
RT Lung Nitrogen Washout 94727	RT Lung Nitrogen Washout 94727	Medicine	94727	CPT	8019395		Washington Regional Medical Center	outpatient	570.36	285.18	Original Medicare	Traditional Medicare Fee-for-Service	268.07	33.81	427.77
RT Non-invasive Managmnt CPAP	RT Non-invasive Managmnt CPAP	Medicine	94660	CPT	7853691		Washington Regional Medical Center	outpatient	767.88	383.94	Self-Pay	Discounted Cash		41.62	575.91
RT Non-invasive Managmnt CPAP	RT Non-invasive Managmnt CPAP	Medicine	94660	CPT	7853691		Washington Regional Medical Center	outpatient	767.88	383.94	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	575.91	41.62	575.91
RT Non-invasive Managmnt CPAP	RT Non-invasive Managmnt CPAP	Medicine	94660	CPT	7853691		Washington Regional Medical Center	outpatient	767.88	383.94	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	337.87	41.62	575.91
RT Non-invasive Managmnt CPAP	RT Non-invasive Managmnt CPAP	Medicine	94660	CPT	7853691		Washington Regional Medical Center	outpatient	767.88	383.94	Humana	Medicare Advantage HMO/PPO/PFFS	360.9	41.62	575.91
RT Non-invasive Managmnt CPAP	RT Non-invasive Managmnt CPAP	Medicine	94660	CPT	7853691		Washington Regional Medical Center	outpatient	767.88	383.94	AmeriHealth Caritas North Carolina	NC Medicaid	269.99	41.62	575.91
RT Non-invasive Managmnt CPAP	RT Non-invasive Managmnt CPAP	Medicine	94660	CPT	7853691		Washington Regional Medical Center	outpatient	767.88	383.94	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	269.99	41.62	575.91
RT Non-invasive Managmnt CPAP	RT Non-invasive Managmnt CPAP	Medicine	94660	CPT	7853691		Washington Regional Medical Center	outpatient	767.88	383.94	WellCare of North Carolina	North Carolina Medicaid/CHIP	269.99	41.62	575.91
RT Non-invasive Managmnt CPAP	RT Non-invasive Managmnt CPAP	Medicine	94660	CPT	7853691		Washington Regional Medical Center	outpatient	767.88	383.94	Healthy Blue / Blue Cross NC	North Carolina Medicaid	269.99	41.62	575.91
RT Non-invasive Managmnt CPAP	RT Non-invasive Managmnt CPAP	Medicine	94660	CPT	7853691		Washington Regional Medical Center	outpatient	767.88	383.94	Cigna	North Carolina PPO-PPA Direct	41.62	41.62	575.91
RT Non-invasive Managmnt CPAP	RT Non-invasive Managmnt CPAP	Medicine	94660	CPT	7853691		Washington Regional Medical Center	outpatient	767.88	383.94	Original Medicare	Traditional Medicare Fee-for-Service	360.9	41.62	575.91
RT Pulse Oximetry, Mult 94761	RT Pulse Oximetry, Mult 94761	Medicine	94761	CPT	8019480		Washington Regional Medical Center	outpatient	9.51	4.76	Self-Pay	Discounted Cash		3.34	7.13
RT Pulse Oximetry, Mult 94761	RT Pulse Oximetry, Mult 94761	Medicine	94761	CPT	8019480		Washington Regional Medical Center	outpatient	9.51	4.76	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	7.13	3.34	7.13
RT Pulse Oximetry, Mult 94761	RT Pulse Oximetry, Mult 94761	Medicine	94761	CPT	8019480		Washington Regional Medical Center	outpatient	9.51	4.76	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	4.18	3.34	7.13
RT Pulse Oximetry, Mult 94761	RT Pulse Oximetry, Mult 94761	Medicine	94761	CPT	8019480		Washington Regional Medical Center	outpatient	9.51	4.76	Humana	Medicare Advantage HMO/PPO/PFFS	4.47	3.34	7.13
RT Pulse Oximetry, Mult 94761	RT Pulse Oximetry, Mult 94761	Medicine	94761	CPT	8019480		Washington Regional Medical Center	outpatient	9.51	4.76	AmeriHealth Caritas North Carolina	NC Medicaid	3.34	3.34	7.13
RT Pulse Oximetry, Mult 94761	RT Pulse Oximetry, Mult 94761	Medicine	94761	CPT	8019480		Washington Regional Medical Center	outpatient	9.51	4.76	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	3.34	3.34	7.13
RT Pulse Oximetry, Mult 94761	RT Pulse Oximetry, Mult 94761	Medicine	94761	CPT	8019480		Washington Regional Medical Center	outpatient	9.51	4.76	WellCare of North Carolina	North Carolina Medicaid/CHIP	3.34	3.34	7.13
RT Pulse Oximetry, Mult 94761	RT Pulse Oximetry, Mult 94761	Medicine	94761	CPT	8019480		Washington Regional Medical Center	outpatient	9.51	4.76	Healthy Blue / Blue Cross NC	North Carolina Medicaid	3.34	3.34	7.13
RT Pulse Oximetry, Mult 94761	RT Pulse Oximetry, Mult 94761	Medicine	94761	CPT	8019480		Washington Regional Medical Center	outpatient	9.51	4.76	Cigna	North Carolina PPO-PPA Direct	4.3	3.34	7.13
RT Pulse Oximetry, Mult 94761	RT Pulse Oximetry, Mult 94761	Medicine	94761	CPT	8019480		Washington Regional Medical Center	outpatient	9.51	4.76	Original Medicare	Traditional Medicare Fee-for-Service	4.47	3.34	7.13
RT Smoke/Tobacco Cnsl>10 99407	RT Smoke/Tobacco Cnsl>10 99407	Medicine	99407	CPT	7882295		Washington Regional Medical Center	outpatient	107.36	53.68	Self-Pay	Discounted Cash		24.39	80.52
RT Smoke/Tobacco Cnsl>10 99407	RT Smoke/Tobacco Cnsl>10 99407	Medicine	99407	CPT	7882295		Washington Regional Medical Center	outpatient	107.36	53.68	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	80.52	24.39	80.52
RT Smoke/Tobacco Cnsl>10 99407	RT Smoke/Tobacco Cnsl>10 99407	Medicine	99407	CPT	7882295		Washington Regional Medical Center	outpatient	107.36	53.68	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	47.24	24.39	80.52
RT Smoke/Tobacco Cnsl>10 99407	RT Smoke/Tobacco Cnsl>10 99407	Medicine	99407	CPT	7882295		Washington Regional Medical Center	outpatient	107.36	53.68	Humana	Medicare Advantage HMO/PPO/PFFS	50.46	24.39	80.52
RT Smoke/Tobacco Cnsl>10 99407	RT Smoke/Tobacco Cnsl>10 99407	Medicine	99407	CPT	7882295		Washington Regional Medical Center	outpatient	107.36	53.68	AmeriHealth Caritas North Carolina	NC Medicaid	37.75	24.39	80.52
RT Smoke/Tobacco Cnsl>10 99407	RT Smoke/Tobacco Cnsl>10 99407	Medicine	99407	CPT	7882295		Washington Regional Medical Center	outpatient	107.36	53.68	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	37.75	24.39	80.52
RT Smoke/Tobacco Cnsl>10 99407	RT Smoke/Tobacco Cnsl>10 99407	Medicine	99407	CPT	7882295		Washington Regional Medical Center	outpatient	107.36	53.68	WellCare of North Carolina	North Carolina Medicaid/CHIP	37.75	24.39	80.52
RT Smoke/Tobacco Cnsl>10 99407	RT Smoke/Tobacco Cnsl>10 99407	Medicine	99407	CPT	7882295		Washington Regional Medical Center	outpatient	107.36	53.68	Healthy Blue / Blue Cross NC	North Carolina Medicaid	37.75	24.39	80.52
RT Smoke/Tobacco Cnsl>10 99407	RT Smoke/Tobacco Cnsl>10 99407	Medicine	99407	CPT	7882295		Washington Regional Medical Center	outpatient	107.36	53.68	Cigna	North Carolina PPO-PPA Direct	24.39	24.39	80.52
RT Smoke/Tobacco Cnsl>10 99407	RT Smoke/Tobacco Cnsl>10 99407	Medicine	99407	CPT	7882295		Washington Regional Medical Center	outpatient	107.36	53.68	Original Medicare	Traditional Medicare Fee-for-Service	50.46	24.39	80.52
RT Vent Management Subsequent	RT Vent Management Subsequent	Medicine	94003	CPT	7880426		Washington Regional Medical Center	outpatient	1990.16	995.08	Self-Pay	Discounted Cash		65.6	1492.62
RT Vent Management Subsequent	RT Vent Management Subsequent	Medicine	94003	CPT	7880426		Washington Regional Medical Center	outpatient	1990.16	995.08	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1492.62	65.6	1492.62
RT Vent Management Subsequent	RT Vent Management Subsequent	Medicine	94003	CPT	7880426		Washington Regional Medical Center	outpatient	1990.16	995.08	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	875.67	65.6	1492.62
RT Vent Management Subsequent	RT Vent Management Subsequent	Medicine	94003	CPT	7880426		Washington Regional Medical Center	outpatient	1990.16	995.08	Humana	Medicare Advantage HMO/PPO/PFFS	935.38	65.6	1492.62
RT Vent Management Subsequent	RT Vent Management Subsequent	Medicine	94003	CPT	7880426		Washington Regional Medical Center	outpatient	1990.16	995.08	AmeriHealth Caritas North Carolina	NC Medicaid	699.74	65.6	1492.62
RT Vent Management Subsequent	RT Vent Management Subsequent	Medicine	94003	CPT	7880426		Washington Regional Medical Center	outpatient	1990.16	995.08	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	699.74	65.6	1492.62
RT Vent Management Subsequent	RT Vent Management Subsequent	Medicine	94003	CPT	7880426		Washington Regional Medical Center	outpatient	1990.16	995.08	WellCare of North Carolina	North Carolina Medicaid/CHIP	699.74	65.6	1492.62
RT Vent Management Subsequent	RT Vent Management Subsequent	Medicine	94003	CPT	7880426		Washington Regional Medical Center	outpatient	1990.16	995.08	Healthy Blue / Blue Cross NC	North Carolina Medicaid	699.74	65.6	1492.62
RT Vent Management Subsequent	RT Vent Management Subsequent	Medicine	94003	CPT	7880426		Washington Regional Medical Center	outpatient	1990.16	995.08	Cigna	North Carolina PPO-PPA Direct	65.6	65.6	1492.62
RT Vent Management Subsequent	RT Vent Management Subsequent	Medicine	94003	CPT	7880426		Washington Regional Medical Center	outpatient	1990.16	995.08	Original Medicare	Traditional Medicare Fee-for-Service	935.38	65.6	1492.62
SB IP CARE/DAY 15 MIN 99231	SB IP CARE/DAY 15 MIN 99231	Medicine	99231	CPT	2389431		Washington Regional Medical Center	outpatient	150.4	75.2	Self-Pay	Discounted Cash		36.35	112.8
SB IP CARE/DAY 15 MIN 99231	SB IP CARE/DAY 15 MIN 99231	Medicine	99231	CPT	2389431		Washington Regional Medical Center	outpatient	150.4	75.2	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	112.8	36.35	112.8
SB IP CARE/DAY 15 MIN 99231	SB IP CARE/DAY 15 MIN 99231	Medicine	99231	CPT	2389431		Washington Regional Medical Center	outpatient	150.4	75.2	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	66.18	36.35	112.8
SB IP CARE/DAY 15 MIN 99231	SB IP CARE/DAY 15 MIN 99231	Medicine	99231	CPT	2389431		Washington Regional Medical Center	outpatient	150.4	75.2	Humana	Medicare Advantage HMO/PPO/PFFS	70.69	36.35	112.8
SB IP CARE/DAY 15 MIN 99231	SB IP CARE/DAY 15 MIN 99231	Medicine	99231	CPT	2389431		Washington Regional Medical Center	outpatient	150.4	75.2	AmeriHealth Caritas North Carolina	NC Medicaid	52.88	36.35	112.8
SB IP CARE/DAY 15 MIN 99231	SB IP CARE/DAY 15 MIN 99231	Medicine	99231	CPT	2389431		Washington Regional Medical Center	outpatient	150.4	75.2	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	52.88	36.35	112.8
SB IP CARE/DAY 15 MIN 99231	SB IP CARE/DAY 15 MIN 99231	Medicine	99231	CPT	2389431		Washington Regional Medical Center	outpatient	150.4	75.2	WellCare of North Carolina	North Carolina Medicaid/CHIP	52.88	36.35	112.8
SB IP CARE/DAY 15 MIN 99231	SB IP CARE/DAY 15 MIN 99231	Medicine	99231	CPT	2389431		Washington Regional Medical Center	outpatient	150.4	75.2	Healthy Blue / Blue Cross NC	North Carolina Medicaid	52.88	36.35	112.8
SB IP CARE/DAY 15 MIN 99231	SB IP CARE/DAY 15 MIN 99231	Medicine	99231	CPT	2389431		Washington Regional Medical Center	outpatient	150.4	75.2	Cigna	North Carolina PPO-PPA Direct	36.35	36.35	112.8
SB IP CARE/DAY 15 MIN 99231	SB IP CARE/DAY 15 MIN 99231	Medicine	99231	CPT	2389431		Washington Regional Medical Center	outpatient	150.4	75.2	Original Medicare	Traditional Medicare Fee-for-Service	70.69	36.35	112.8
SB NRS FAC/DAY E/M 25 M 99309	SB NRS FAC/DAY E/M 25 M 99309	Medicine	99309	CPT	2389462		Washington Regional Medical Center	outpatient	350.48	175.24	Self-Pay	Discounted Cash		84.7	262.86
SB NRS FAC/DAY E/M 25 M 99309	SB NRS FAC/DAY E/M 25 M 99309	Medicine	99309	CPT	2389462		Washington Regional Medical Center	outpatient	350.48	175.24	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	262.86	84.7	262.86
SB NRS FAC/DAY E/M 25 M 99309	SB NRS FAC/DAY E/M 25 M 99309	Medicine	99309	CPT	2389462		Washington Regional Medical Center	outpatient	350.48	175.24	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	154.21	84.7	262.86
SB NRS FAC/DAY E/M 25 M 99309	SB NRS FAC/DAY E/M 25 M 99309	Medicine	99309	CPT	2389462		Washington Regional Medical Center	outpatient	350.48	175.24	Humana	Medicare Advantage HMO/PPO/PFFS	164.73	84.7	262.86
SB NRS FAC/DAY E/M 25 M 99309	SB NRS FAC/DAY E/M 25 M 99309	Medicine	99309	CPT	2389462		Washington Regional Medical Center	outpatient	350.48	175.24	AmeriHealth Caritas North Carolina	NC Medicaid	123.23	84.7	262.86
SB NRS FAC/DAY E/M 25 M 99309	SB NRS FAC/DAY E/M 25 M 99309	Medicine	99309	CPT	2389462		Washington Regional Medical Center	outpatient	350.48	175.24	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	123.23	84.7	262.86
SB NRS FAC/DAY E/M 25 M 99309	SB NRS FAC/DAY E/M 25 M 99309	Medicine	99309	CPT	2389462		Washington Regional Medical Center	outpatient	350.48	175.24	WellCare of North Carolina	North Carolina Medicaid/CHIP	123.23	84.7	262.86
SB NRS FAC/DAY E/M 25 M 99309	SB NRS FAC/DAY E/M 25 M 99309	Medicine	99309	CPT	2389462		Washington Regional Medical Center	outpatient	350.48	175.24	Healthy Blue / Blue Cross NC	North Carolina Medicaid	123.23	84.7	262.86
SB NRS FAC/DAY E/M 25 M 99309	SB NRS FAC/DAY E/M 25 M 99309	Medicine	99309	CPT	2389462		Washington Regional Medical Center	outpatient	350.48	175.24	Cigna	North Carolina PPO-PPA Direct	84.7	84.7	262.86
SB NRS FAC/DAY E/M 25 M 99309	SB NRS FAC/DAY E/M 25 M 99309	Medicine	99309	CPT	2389462		Washington Regional Medical Center	outpatient	350.48	175.24	Original Medicare	Traditional Medicare Fee-for-Service	164.73	84.7	262.86
SB OBSV CARE/DAY 25 MIN 99225	SB OBSV CARE/DAY 25 MIN 99225	Medicine	99225	CPT	2389429		Washington Regional Medical Center	outpatient	275.68	137.84	Self-Pay	Discounted Cash		58.32	206.76
SB OBSV CARE/DAY 25 MIN 99225	SB OBSV CARE/DAY 25 MIN 99225	Medicine	99225	CPT	2389429		Washington Regional Medical Center	outpatient	275.68	137.84	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	206.76	58.32	206.76
SB OBSV CARE/DAY 25 MIN 99225	SB OBSV CARE/DAY 25 MIN 99225	Medicine	99225	CPT	2389429		Washington Regional Medical Center	outpatient	275.68	137.84	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	121.3	58.32	206.76
SB OBSV CARE/DAY 25 MIN 99225	SB OBSV CARE/DAY 25 MIN 99225	Medicine	99225	CPT	2389429		Washington Regional Medical Center	outpatient	275.68	137.84	Humana	Medicare Advantage HMO/PPO/PFFS	129.57	58.32	206.76
SB OBSV CARE/DAY 25 MIN 99225	SB OBSV CARE/DAY 25 MIN 99225	Medicine	99225	CPT	2389429		Washington Regional Medical Center	outpatient	275.68	137.84	AmeriHealth Caritas North Carolina	NC Medicaid	96.93	58.32	206.76
SB OBSV CARE/DAY 25 MIN 99225	SB OBSV CARE/DAY 25 MIN 99225	Medicine	99225	CPT	2389429		Washington Regional Medical Center	outpatient	275.68	137.84	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	96.93	58.32	206.76
SB OBSV CARE/DAY 25 MIN 99225	SB OBSV CARE/DAY 25 MIN 99225	Medicine	99225	CPT	2389429		Washington Regional Medical Center	outpatient	275.68	137.84	WellCare of North Carolina	North Carolina Medicaid/CHIP	96.93	58.32	206.76
SB OBSV CARE/DAY 25 MIN 99225	SB OBSV CARE/DAY 25 MIN 99225	Medicine	99225	CPT	2389429		Washington Regional Medical Center	outpatient	275.68	137.84	Healthy Blue / Blue Cross NC	North Carolina Medicaid	96.93	58.32	206.76
SB OBSV CARE/DAY 25 MIN 99225	SB OBSV CARE/DAY 25 MIN 99225	Medicine	99225	CPT	2389429		Washington Regional Medical Center	outpatient	275.68	137.84	Cigna	North Carolina PPO-PPA Direct	58.32	58.32	206.76
SB OBSV CARE/DAY 25 MIN 99225	SB OBSV CARE/DAY 25 MIN 99225	Medicine	99225	CPT	2389429		Washington Regional Medical Center	outpatient	275.68	137.84	Original Medicare	Traditional Medicare Fee-for-Service	129.57	58.32	206.76
SPECIAL CONSULTATION – LEVEL 2	SPECIAL CONSULTATION – LEVEL 2	Medicine	99222	CPT	7500371		Washington Regional Medical Center	outpatient	524.96	262.48	Self-Pay	Discounted Cash		120.41	393.72
SPECIAL CONSULTATION – LEVEL 2	SPECIAL CONSULTATION – LEVEL 2	Medicine	99222	CPT	7500371		Washington Regional Medical Center	outpatient	524.96	262.48	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	393.72	120.41	393.72
SPECIAL CONSULTATION – LEVEL 2	SPECIAL CONSULTATION – LEVEL 2	Medicine	99222	CPT	7500371		Washington Regional Medical Center	outpatient	524.96	262.48	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	230.98	120.41	393.72
SPECIAL CONSULTATION – LEVEL 2	SPECIAL CONSULTATION – LEVEL 2	Medicine	99222	CPT	7500371		Washington Regional Medical Center	outpatient	524.96	262.48	Humana	Medicare Advantage HMO/PPO/PFFS	246.73	120.41	393.72
SPECIAL CONSULTATION – LEVEL 2	SPECIAL CONSULTATION – LEVEL 2	Medicine	99222	CPT	7500371		Washington Regional Medical Center	outpatient	524.96	262.48	AmeriHealth Caritas North Carolina	NC Medicaid	184.58	120.41	393.72
SPECIAL CONSULTATION – LEVEL 2	SPECIAL CONSULTATION – LEVEL 2	Medicine	99222	CPT	7500371		Washington Regional Medical Center	outpatient	524.96	262.48	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	184.58	120.41	393.72
SPECIAL CONSULTATION – LEVEL 2	SPECIAL CONSULTATION – LEVEL 2	Medicine	99222	CPT	7500371		Washington Regional Medical Center	outpatient	524.96	262.48	WellCare of North Carolina	North Carolina Medicaid/CHIP	184.58	120.41	393.72
SPECIAL CONSULTATION – LEVEL 2	SPECIAL CONSULTATION – LEVEL 2	Medicine	99222	CPT	7500371		Washington Regional Medical Center	outpatient	524.96	262.48	Healthy Blue / Blue Cross NC	North Carolina Medicaid	184.58	120.41	393.72
SPECIAL CONSULTATION – LEVEL 2	SPECIAL CONSULTATION – LEVEL 2	Medicine	99222	CPT	7500371		Washington Regional Medical Center	outpatient	524.96	262.48	Cigna	North Carolina PPO-PPA Direct	120.41	120.41	393.72
SPECIAL CONSULTATION – LEVEL 2	SPECIAL CONSULTATION – LEVEL 2	Medicine	99222	CPT	7500371		Washington Regional Medical Center	outpatient	524.96	262.48	Original Medicare	Traditional Medicare Fee-for-Service	246.73	120.41	393.72
SPORTS PHYSICAL	SPORTS PHYSICAL	Medicine	99070	CPT	8001076		Washington Regional Medical Center	outpatient	32	16	Self-Pay	Discounted Cash		11.25	24
SPORTS PHYSICAL	SPORTS PHYSICAL	Medicine	99070	CPT	8001076		Washington Regional Medical Center	outpatient	32	16	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	24	11.25	24
SPORTS PHYSICAL	SPORTS PHYSICAL	Medicine	99070	CPT	8001076		Washington Regional Medical Center	outpatient	32	16	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	14.08	11.25	24
SPORTS PHYSICAL	SPORTS PHYSICAL	Medicine	99070	CPT	8001076		Washington Regional Medical Center	outpatient	32	16	Humana	Medicare Advantage HMO/PPO/PFFS	15.04	11.25	24
SPORTS PHYSICAL	SPORTS PHYSICAL	Medicine	99070	CPT	8001076		Washington Regional Medical Center	outpatient	32	16	AmeriHealth Caritas North Carolina	NC Medicaid	11.25	11.25	24
SPORTS PHYSICAL	SPORTS PHYSICAL	Medicine	99070	CPT	8001076		Washington Regional Medical Center	outpatient	32	16	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	11.25	11.25	24
SPORTS PHYSICAL	SPORTS PHYSICAL	Medicine	99070	CPT	8001076		Washington Regional Medical Center	outpatient	32	16	WellCare of North Carolina	North Carolina Medicaid/CHIP	11.25	11.25	24
SPORTS PHYSICAL	SPORTS PHYSICAL	Medicine	99070	CPT	8001076		Washington Regional Medical Center	outpatient	32	16	Healthy Blue / Blue Cross NC	North Carolina Medicaid	11.25	11.25	24
SPORTS PHYSICAL	SPORTS PHYSICAL	Medicine	99070	CPT	8001076		Washington Regional Medical Center	outpatient	32	16	Original Medicare	Traditional Medicare Fee-for-Service	15.04	11.25	24
SPT Therapeutic Inter	SPT Therapeutic Inter	Medicine	97129	CPT	4300001		Washington Regional Medical Center	outpatient	209	104.5	Self-Pay	Discounted Cash		20.99	156.75
SPT Therapeutic Inter	SPT Therapeutic Inter	Medicine	97129	CPT	4300001		Washington Regional Medical Center	outpatient	209	104.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	156.75	20.99	156.75
SPT Therapeutic Inter	SPT Therapeutic Inter	Medicine	97129	CPT	4300001		Washington Regional Medical Center	outpatient	209	104.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	91.96	20.99	156.75
SPT Therapeutic Inter	SPT Therapeutic Inter	Medicine	97129	CPT	4300001		Washington Regional Medical Center	outpatient	209	104.5	Humana	Medicare Advantage HMO/PPO/PFFS	98.23	20.99	156.75
SPT Therapeutic Inter	SPT Therapeutic Inter	Medicine	97129	CPT	4300001		Washington Regional Medical Center	outpatient	209	104.5	AmeriHealth Caritas North Carolina	NC Medicaid	73.48	20.99	156.75
SPT Therapeutic Inter	SPT Therapeutic Inter	Medicine	97129	CPT	4300001		Washington Regional Medical Center	outpatient	209	104.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	73.48	20.99	156.75
SPT Therapeutic Inter	SPT Therapeutic Inter	Medicine	97129	CPT	4300001		Washington Regional Medical Center	outpatient	209	104.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	73.48	20.99	156.75
SPT Therapeutic Inter	SPT Therapeutic Inter	Medicine	97129	CPT	4300001		Washington Regional Medical Center	outpatient	209	104.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	73.48	20.99	156.75
SPT Therapeutic Inter	SPT Therapeutic Inter	Medicine	97129	CPT	4300001		Washington Regional Medical Center	outpatient	209	104.5	Cigna	North Carolina PPO-PPA Direct	20.99	20.99	156.75
SPT Therapeutic Inter	SPT Therapeutic Inter	Medicine	97129	CPT	4300001		Washington Regional Medical Center	outpatient	209	104.5	Original Medicare	Traditional Medicare Fee-for-Service	98.23	20.99	156.75
ST EVAL ORAL/PHAR SWALLOW FUNC	ST EVAL ORAL/PHAR SWALLOW FUNC	Medicine	92610	CPT	4301001		Washington Regional Medical Center	outpatient	318	159	Self-Pay	Discounted Cash		111.81	238.5
ST EVAL ORAL/PHAR SWALLOW FUNC	ST EVAL ORAL/PHAR SWALLOW FUNC	Medicine	92610	CPT	4301001		Washington Regional Medical Center	outpatient	318	159	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	238.5	111.81	238.5
ST EVAL ORAL/PHAR SWALLOW FUNC	ST EVAL ORAL/PHAR SWALLOW FUNC	Medicine	92610	CPT	4301001		Washington Regional Medical Center	outpatient	318	159	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	139.92	111.81	238.5
ST EVAL ORAL/PHAR SWALLOW FUNC	ST EVAL ORAL/PHAR SWALLOW FUNC	Medicine	92610	CPT	4301001		Washington Regional Medical Center	outpatient	318	159	Humana	Medicare Advantage HMO/PPO/PFFS	149.46	111.81	238.5
ST EVAL ORAL/PHAR SWALLOW FUNC	ST EVAL ORAL/PHAR SWALLOW FUNC	Medicine	92610	CPT	4301001		Washington Regional Medical Center	outpatient	318	159	AmeriHealth Caritas North Carolina	NC Medicaid	111.81	111.81	238.5
ST EVAL ORAL/PHAR SWALLOW FUNC	ST EVAL ORAL/PHAR SWALLOW FUNC	Medicine	92610	CPT	4301001		Washington Regional Medical Center	outpatient	318	159	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	111.81	111.81	238.5
ST EVAL ORAL/PHAR SWALLOW FUNC	ST EVAL ORAL/PHAR SWALLOW FUNC	Medicine	92610	CPT	4301001		Washington Regional Medical Center	outpatient	318	159	WellCare of North Carolina	North Carolina Medicaid/CHIP	111.81	111.81	238.5
ST EVAL ORAL/PHAR SWALLOW FUNC	ST EVAL ORAL/PHAR SWALLOW FUNC	Medicine	92610	CPT	4301001		Washington Regional Medical Center	outpatient	318	159	Healthy Blue / Blue Cross NC	North Carolina Medicaid	111.81	111.81	238.5
ST EVAL ORAL/PHAR SWALLOW FUNC	ST EVAL ORAL/PHAR SWALLOW FUNC	Medicine	92610	CPT	4301001		Washington Regional Medical Center	outpatient	318	159	Cigna	North Carolina PPO-PPA Direct	134.4	111.81	238.5
ST EVAL ORAL/PHAR SWALLOW FUNC	ST EVAL ORAL/PHAR SWALLOW FUNC	Medicine	92610	CPT	4301001		Washington Regional Medical Center	outpatient	318	159	Original Medicare	Traditional Medicare Fee-for-Service	149.46	111.81	238.5
ST EVALUATE SPEECH PRODUCTION	ST EVALUATE SPEECH PRODUCTION	Medicine	92522	CPT	4301036		Washington Regional Medical Center	outpatient	193	96.5	Self-Pay	Discounted Cash		67.86	144.75
ST EVALUATE SPEECH PRODUCTION	ST EVALUATE SPEECH PRODUCTION	Medicine	92522	CPT	4301036		Washington Regional Medical Center	outpatient	193	96.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	144.75	67.86	144.75
ST EVALUATE SPEECH PRODUCTION	ST EVALUATE SPEECH PRODUCTION	Medicine	92522	CPT	4301036		Washington Regional Medical Center	outpatient	193	96.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	84.92	67.86	144.75
ST EVALUATE SPEECH PRODUCTION	ST EVALUATE SPEECH PRODUCTION	Medicine	92522	CPT	4301036		Washington Regional Medical Center	outpatient	193	96.5	Humana	Medicare Advantage HMO/PPO/PFFS	90.71	67.86	144.75
ST EVALUATE SPEECH PRODUCTION	ST EVALUATE SPEECH PRODUCTION	Medicine	92522	CPT	4301036		Washington Regional Medical Center	outpatient	193	96.5	AmeriHealth Caritas North Carolina	NC Medicaid	67.86	67.86	144.75
ST EVALUATE SPEECH PRODUCTION	ST EVALUATE SPEECH PRODUCTION	Medicine	92522	CPT	4301036		Washington Regional Medical Center	outpatient	193	96.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	67.86	67.86	144.75
ST EVALUATE SPEECH PRODUCTION	ST EVALUATE SPEECH PRODUCTION	Medicine	92522	CPT	4301036		Washington Regional Medical Center	outpatient	193	96.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	67.86	67.86	144.75
ST EVALUATE SPEECH PRODUCTION	ST EVALUATE SPEECH PRODUCTION	Medicine	92522	CPT	4301036		Washington Regional Medical Center	outpatient	193	96.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	67.86	67.86	144.75
ST EVALUATE SPEECH PRODUCTION	ST EVALUATE SPEECH PRODUCTION	Medicine	92522	CPT	4301036		Washington Regional Medical Center	outpatient	193	96.5	Cigna	North Carolina PPO-PPA Direct	104.21	67.86	144.75
ST EVALUATE SPEECH PRODUCTION	ST EVALUATE SPEECH PRODUCTION	Medicine	92522	CPT	4301036		Washington Regional Medical Center	outpatient	193	96.5	Original Medicare	Traditional Medicare Fee-for-Service	90.71	67.86	144.75
ST TX ORAL FUNCTION THERAPY	ST TX ORAL FUNCTION THERAPY	Medicine	92526	CPT	4301006		Washington Regional Medical Center	outpatient	293	146.5	Self-Pay	Discounted Cash		31.17	219.75
ST TX ORAL FUNCTION THERAPY	ST TX ORAL FUNCTION THERAPY	Medicine	92526	CPT	4301006		Washington Regional Medical Center	outpatient	293	146.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	219.75	31.17	219.75
ST TX ORAL FUNCTION THERAPY	ST TX ORAL FUNCTION THERAPY	Medicine	92526	CPT	4301006		Washington Regional Medical Center	outpatient	293	146.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	128.92	31.17	219.75
ST TX ORAL FUNCTION THERAPY	ST TX ORAL FUNCTION THERAPY	Medicine	92526	CPT	4301006		Washington Regional Medical Center	outpatient	293	146.5	Humana	Medicare Advantage HMO/PPO/PFFS	137.71	31.17	219.75
ST TX ORAL FUNCTION THERAPY	ST TX ORAL FUNCTION THERAPY	Medicine	92526	CPT	4301006		Washington Regional Medical Center	outpatient	293	146.5	AmeriHealth Caritas North Carolina	NC Medicaid	103.02	31.17	219.75
ST TX ORAL FUNCTION THERAPY	ST TX ORAL FUNCTION THERAPY	Medicine	92526	CPT	4301006		Washington Regional Medical Center	outpatient	293	146.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	103.02	31.17	219.75
ST TX ORAL FUNCTION THERAPY	ST TX ORAL FUNCTION THERAPY	Medicine	92526	CPT	4301006		Washington Regional Medical Center	outpatient	293	146.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	103.02	31.17	219.75
ST TX ORAL FUNCTION THERAPY	ST TX ORAL FUNCTION THERAPY	Medicine	92526	CPT	4301006		Washington Regional Medical Center	outpatient	293	146.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	103.02	31.17	219.75
ST TX ORAL FUNCTION THERAPY	ST TX ORAL FUNCTION THERAPY	Medicine	92526	CPT	4301006		Washington Regional Medical Center	outpatient	293	146.5	Cigna	North Carolina PPO-PPA Direct	31.17	31.17	219.75
ST TX ORAL FUNCTION THERAPY	ST TX ORAL FUNCTION THERAPY	Medicine	92526	CPT	4301006		Washington Regional Medical Center	outpatient	293	146.5	Original Medicare	Traditional Medicare Fee-for-Service	137.71	31.17	219.75
Sub. Hospital Care Level 1	Sub. Hospital Care Level 1	Medicine	99231	CPT	98704010		Washington Regional Medical Center	outpatient	150.4	75.2	Self-Pay	Discounted Cash		36.35	112.8
Sub. Hospital Care Level 1	Sub. Hospital Care Level 1	Medicine	99231	CPT	98704010		Washington Regional Medical Center	outpatient	150.4	75.2	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	112.8	36.35	112.8
Sub. Hospital Care Level 1	Sub. Hospital Care Level 1	Medicine	99231	CPT	98704010		Washington Regional Medical Center	outpatient	150.4	75.2	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	66.18	36.35	112.8
Sub. Hospital Care Level 1	Sub. Hospital Care Level 1	Medicine	99231	CPT	98704010		Washington Regional Medical Center	outpatient	150.4	75.2	Humana	Medicare Advantage HMO/PPO/PFFS	70.69	36.35	112.8
Sub. Hospital Care Level 1	Sub. Hospital Care Level 1	Medicine	99231	CPT	98704010		Washington Regional Medical Center	outpatient	150.4	75.2	AmeriHealth Caritas North Carolina	NC Medicaid	52.88	36.35	112.8
Sub. Hospital Care Level 1	Sub. Hospital Care Level 1	Medicine	99231	CPT	98704010		Washington Regional Medical Center	outpatient	150.4	75.2	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	52.88	36.35	112.8
Sub. Hospital Care Level 1	Sub. Hospital Care Level 1	Medicine	99231	CPT	98704010		Washington Regional Medical Center	outpatient	150.4	75.2	WellCare of North Carolina	North Carolina Medicaid/CHIP	52.88	36.35	112.8
Sub. Hospital Care Level 1	Sub. Hospital Care Level 1	Medicine	99231	CPT	98704010		Washington Regional Medical Center	outpatient	150.4	75.2	Healthy Blue / Blue Cross NC	North Carolina Medicaid	52.88	36.35	112.8
Sub. Hospital Care Level 1	Sub. Hospital Care Level 1	Medicine	99231	CPT	98704010		Washington Regional Medical Center	outpatient	150.4	75.2	Cigna	North Carolina PPO-PPA Direct	36.35	36.35	112.8
Sub. Hospital Care Level 1	Sub. Hospital Care Level 1	Medicine	99231	CPT	98704010		Washington Regional Medical Center	outpatient	150.4	75.2	Original Medicare	Traditional Medicare Fee-for-Service	70.69	36.35	112.8
SUTURE REMOVAL/RECHECK	SUTURE REMOVAL/RECHECK	Medicine	99211	CPT	6001040		Washington Regional Medical Center	outpatient	40.47	20.24	Self-Pay	Discounted Cash		9.67	30.35
SUTURE REMOVAL/RECHECK	SUTURE REMOVAL/RECHECK	Medicine	99211	CPT	6001040		Washington Regional Medical Center	outpatient	40.47	20.24	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	30.35	9.67	30.35
SUTURE REMOVAL/RECHECK	SUTURE REMOVAL/RECHECK	Medicine	99211	CPT	6001040		Washington Regional Medical Center	outpatient	40.47	20.24	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	17.81	9.67	30.35
SUTURE REMOVAL/RECHECK	SUTURE REMOVAL/RECHECK	Medicine	99211	CPT	6001040		Washington Regional Medical Center	outpatient	40.47	20.24	Humana	Medicare Advantage HMO/PPO/PFFS	19.02	9.67	30.35
SUTURE REMOVAL/RECHECK	SUTURE REMOVAL/RECHECK	Medicine	99211	CPT	6001040		Washington Regional Medical Center	outpatient	40.47	20.24	AmeriHealth Caritas North Carolina	NC Medicaid	14.23	9.67	30.35
SUTURE REMOVAL/RECHECK	SUTURE REMOVAL/RECHECK	Medicine	99211	CPT	6001040		Washington Regional Medical Center	outpatient	40.47	20.24	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	14.23	9.67	30.35
SUTURE REMOVAL/RECHECK	SUTURE REMOVAL/RECHECK	Medicine	99211	CPT	6001040		Washington Regional Medical Center	outpatient	40.47	20.24	WellCare of North Carolina	North Carolina Medicaid/CHIP	14.23	9.67	30.35
SUTURE REMOVAL/RECHECK	SUTURE REMOVAL/RECHECK	Medicine	99211	CPT	6001040		Washington Regional Medical Center	outpatient	40.47	20.24	Healthy Blue / Blue Cross NC	North Carolina Medicaid	14.23	9.67	30.35
SUTURE REMOVAL/RECHECK	SUTURE REMOVAL/RECHECK	Medicine	99211	CPT	6001040		Washington Regional Medical Center	outpatient	40.47	20.24	Cigna	North Carolina PPO-PPA Direct	9.67	9.67	30.35
SUTURE REMOVAL/RECHECK	SUTURE REMOVAL/RECHECK	Medicine	99211	CPT	6001040		Washington Regional Medical Center	outpatient	40.47	20.24	Original Medicare	Traditional Medicare Fee-for-Service	19.02	9.67	30.35
TEMP TRANSCUT PACING	TEMP TRANSCUT PACING	Medicine	92953	CPT	6001017		Washington Regional Medical Center	outpatient	1721.19	860.6	Self-Pay	Discounted Cash		12.82	1290.89
TEMP TRANSCUT PACING	TEMP TRANSCUT PACING	Medicine	92953	CPT	6001017		Washington Regional Medical Center	outpatient	1721.19	860.6	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1290.89	12.82	1290.89
TEMP TRANSCUT PACING	TEMP TRANSCUT PACING	Medicine	92953	CPT	6001017		Washington Regional Medical Center	outpatient	1721.19	860.6	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	757.32	12.82	1290.89
TEMP TRANSCUT PACING	TEMP TRANSCUT PACING	Medicine	92953	CPT	6001017		Washington Regional Medical Center	outpatient	1721.19	860.6	Humana	Medicare Advantage HMO/PPO/PFFS	808.96	12.82	1290.89
TEMP TRANSCUT PACING	TEMP TRANSCUT PACING	Medicine	92953	CPT	6001017		Washington Regional Medical Center	outpatient	1721.19	860.6	AmeriHealth Caritas North Carolina	NC Medicaid	605.17	12.82	1290.89
TEMP TRANSCUT PACING	TEMP TRANSCUT PACING	Medicine	92953	CPT	6001017		Washington Regional Medical Center	outpatient	1721.19	860.6	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	605.17	12.82	1290.89
TEMP TRANSCUT PACING	TEMP TRANSCUT PACING	Medicine	92953	CPT	6001017		Washington Regional Medical Center	outpatient	1721.19	860.6	WellCare of North Carolina	North Carolina Medicaid/CHIP	605.17	12.82	1290.89
TEMP TRANSCUT PACING	TEMP TRANSCUT PACING	Medicine	92953	CPT	6001017		Washington Regional Medical Center	outpatient	1721.19	860.6	Healthy Blue / Blue Cross NC	North Carolina Medicaid	605.17	12.82	1290.89
TEMP TRANSCUT PACING	TEMP TRANSCUT PACING	Medicine	92953	CPT	6001017		Washington Regional Medical Center	outpatient	1721.19	860.6	Cigna	North Carolina PPO-PPA Direct	12.82	12.82	1290.89
TEMP TRANSCUT PACING	TEMP TRANSCUT PACING	Medicine	92953	CPT	6001017		Washington Regional Medical Center	outpatient	1721.19	860.6	Original Medicare	Traditional Medicare Fee-for-Service	808.96	12.82	1290.89
THER/PROPH/DX INJECT IM/SQ	THER/PROPH/DX INJECT IM/SQ	Medicine	96372	CPT	6000032		Washington Regional Medical Center	outpatient	189.96	94.98	Self-Pay	Discounted Cash		22.78	142.47
THER/PROPH/DX INJECT IM/SQ	THER/PROPH/DX INJECT IM/SQ	Medicine	96372	CPT	6000032		Washington Regional Medical Center	outpatient	189.96	94.98	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	142.47	22.78	142.47
THER/PROPH/DX INJECT IM/SQ	THER/PROPH/DX INJECT IM/SQ	Medicine	96372	CPT	6000032		Washington Regional Medical Center	outpatient	189.96	94.98	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	83.58	22.78	142.47
THER/PROPH/DX INJECT IM/SQ	THER/PROPH/DX INJECT IM/SQ	Medicine	96372	CPT	6000032		Washington Regional Medical Center	outpatient	189.96	94.98	Humana	Medicare Advantage HMO/PPO/PFFS	89.28	22.78	142.47
THER/PROPH/DX INJECT IM/SQ	THER/PROPH/DX INJECT IM/SQ	Medicine	96372	CPT	6000032		Washington Regional Medical Center	outpatient	189.96	94.98	AmeriHealth Caritas North Carolina	NC Medicaid	66.79	22.78	142.47
THER/PROPH/DX INJECT IM/SQ	THER/PROPH/DX INJECT IM/SQ	Medicine	96372	CPT	6000032		Washington Regional Medical Center	outpatient	189.96	94.98	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	66.79	22.78	142.47
THER/PROPH/DX INJECT IM/SQ	THER/PROPH/DX INJECT IM/SQ	Medicine	96372	CPT	6000032		Washington Regional Medical Center	outpatient	189.96	94.98	WellCare of North Carolina	North Carolina Medicaid/CHIP	66.79	22.78	142.47
THER/PROPH/DX INJECT IM/SQ	THER/PROPH/DX INJECT IM/SQ	Medicine	96372	CPT	6000032		Washington Regional Medical Center	outpatient	189.96	94.98	Healthy Blue / Blue Cross NC	North Carolina Medicaid	66.79	22.78	142.47
THER/PROPH/DX INJECT IM/SQ	THER/PROPH/DX INJECT IM/SQ	Medicine	96372	CPT	6000032		Washington Regional Medical Center	outpatient	189.96	94.98	Cigna	North Carolina PPO-PPA Direct	22.78	22.78	142.47
THER/PROPH/DX INJECT IM/SQ	THER/PROPH/DX INJECT IM/SQ	Medicine	96372	CPT	6000032		Washington Regional Medical Center	outpatient	189.96	94.98	Original Medicare	Traditional Medicare Fee-for-Service	89.28	22.78	142.47
THORA	THORA	Medicine	99211	CPT	10491102		Washington Regional Medical Center	outpatient	89	44.5	Self-Pay	Discounted Cash		9.67	66.75
THORA	THORA	Medicine	99211	CPT	10491102		Washington Regional Medical Center	outpatient	89	44.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	66.75	9.67	66.75
THORA	THORA	Medicine	99211	CPT	10491102		Washington Regional Medical Center	outpatient	89	44.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	39.16	9.67	66.75
THORA	THORA	Medicine	99211	CPT	10491102		Washington Regional Medical Center	outpatient	89	44.5	Humana	Medicare Advantage HMO/PPO/PFFS	41.83	9.67	66.75
THORA	THORA	Medicine	99211	CPT	10491102		Washington Regional Medical Center	outpatient	89	44.5	AmeriHealth Caritas North Carolina	NC Medicaid	31.29	9.67	66.75
THORA	THORA	Medicine	99211	CPT	10491102		Washington Regional Medical Center	outpatient	89	44.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	31.29	9.67	66.75
THORA	THORA	Medicine	99211	CPT	10491102		Washington Regional Medical Center	outpatient	89	44.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	31.29	9.67	66.75
THORA	THORA	Medicine	99211	CPT	10491102		Washington Regional Medical Center	outpatient	89	44.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	31.29	9.67	66.75
THORA	THORA	Medicine	99211	CPT	10491102		Washington Regional Medical Center	outpatient	89	44.5	Cigna	North Carolina PPO-PPA Direct	9.67	9.67	66.75
THORA	THORA	Medicine	99211	CPT	10491102		Washington Regional Medical Center	outpatient	89	44.5	Original Medicare	Traditional Medicare Fee-for-Service	41.83	9.67	66.75
TLHTH OCC THER EVAL HI 60 MIN	TLHTH OCC THER EVAL HI 60 MIN	Medicine	97167	CPT	4401005		Washington Regional Medical Center	outpatient	322	161	Self-Pay	Discounted Cash		67.83	241.5
TLHTH OCC THER EVAL HI 60 MIN	TLHTH OCC THER EVAL HI 60 MIN	Medicine	97167	CPT	4401005		Washington Regional Medical Center	outpatient	322	161	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	241.5	67.83	241.5
TLHTH OCC THER EVAL HI 60 MIN	TLHTH OCC THER EVAL HI 60 MIN	Medicine	97167	CPT	4401005		Washington Regional Medical Center	outpatient	322	161	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	141.68	67.83	241.5
TLHTH OCC THER EVAL HI 60 MIN	TLHTH OCC THER EVAL HI 60 MIN	Medicine	97167	CPT	4401005		Washington Regional Medical Center	outpatient	322	161	Humana	Medicare Advantage HMO/PPO/PFFS	151.34	67.83	241.5
TLHTH OCC THER EVAL HI 60 MIN	TLHTH OCC THER EVAL HI 60 MIN	Medicine	97167	CPT	4401005		Washington Regional Medical Center	outpatient	322	161	AmeriHealth Caritas North Carolina	NC Medicaid	113.22	67.83	241.5
TLHTH OCC THER EVAL HI 60 MIN	TLHTH OCC THER EVAL HI 60 MIN	Medicine	97167	CPT	4401005		Washington Regional Medical Center	outpatient	322	161	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	72.71	67.83	241.5
TLHTH OCC THER EVAL HI 60 MIN	TLHTH OCC THER EVAL HI 60 MIN	Medicine	97167	CPT	4401005		Washington Regional Medical Center	outpatient	322	161	WellCare of North Carolina	North Carolina Medicaid/CHIP	113.22	67.83	241.5
TLHTH OCC THER EVAL HI 60 MIN	TLHTH OCC THER EVAL HI 60 MIN	Medicine	97167	CPT	4401005		Washington Regional Medical Center	outpatient	322	161	Healthy Blue / Blue Cross NC	North Carolina Medicaid	113.22	67.83	241.5
TLHTH OCC THER EVAL HI 60 MIN	TLHTH OCC THER EVAL HI 60 MIN	Medicine	97167	CPT	4401005		Washington Regional Medical Center	outpatient	322	161	Cigna	North Carolina PPO-PPA Direct	67.83	67.83	241.5
TLHTH OCC THER EVAL HI 60 MIN	TLHTH OCC THER EVAL HI 60 MIN	Medicine	97167	CPT	4401005		Washington Regional Medical Center	outpatient	322	161	Original Medicare	Traditional Medicare Fee-for-Service	151.34	67.83	241.5
TLHTH OCC THR EVAL LOW 30 MINS	TLHTH OCC THR EVAL LOW 30 MINS	Medicine	97165	CPT	4401003		Washington Regional Medical Center	outpatient	304	152	Self-Pay	Discounted Cash		67.83	228
TLHTH OCC THR EVAL LOW 30 MINS	TLHTH OCC THR EVAL LOW 30 MINS	Medicine	97165	CPT	4401003		Washington Regional Medical Center	outpatient	304	152	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	228	67.83	228
TLHTH OCC THR EVAL LOW 30 MINS	TLHTH OCC THR EVAL LOW 30 MINS	Medicine	97165	CPT	4401003		Washington Regional Medical Center	outpatient	304	152	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	133.76	67.83	228
TLHTH OCC THR EVAL LOW 30 MINS	TLHTH OCC THR EVAL LOW 30 MINS	Medicine	97165	CPT	4401003		Washington Regional Medical Center	outpatient	304	152	Humana	Medicare Advantage HMO/PPO/PFFS	142.88	67.83	228
TLHTH OCC THR EVAL LOW 30 MINS	TLHTH OCC THR EVAL LOW 30 MINS	Medicine	97165	CPT	4401003		Washington Regional Medical Center	outpatient	304	152	AmeriHealth Caritas North Carolina	NC Medicaid	106.89	67.83	228
TLHTH OCC THR EVAL LOW 30 MINS	TLHTH OCC THR EVAL LOW 30 MINS	Medicine	97165	CPT	4401003		Washington Regional Medical Center	outpatient	304	152	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	72.71	67.83	228
TLHTH OCC THR EVAL LOW 30 MINS	TLHTH OCC THR EVAL LOW 30 MINS	Medicine	97165	CPT	4401003		Washington Regional Medical Center	outpatient	304	152	WellCare of North Carolina	North Carolina Medicaid/CHIP	106.89	67.83	228
TLHTH OCC THR EVAL LOW 30 MINS	TLHTH OCC THR EVAL LOW 30 MINS	Medicine	97165	CPT	4401003		Washington Regional Medical Center	outpatient	304	152	Healthy Blue / Blue Cross NC	North Carolina Medicaid	106.89	67.83	228
TLHTH OCC THR EVAL LOW 30 MINS	TLHTH OCC THR EVAL LOW 30 MINS	Medicine	97165	CPT	4401003		Washington Regional Medical Center	outpatient	304	152	Cigna	North Carolina PPO-PPA Direct	67.83	67.83	228
TLHTH OCC THR EVAL LOW 30 MINS	TLHTH OCC THR EVAL LOW 30 MINS	Medicine	97165	CPT	4401003		Washington Regional Medical Center	outpatient	304	152	Original Medicare	Traditional Medicare Fee-for-Service	142.88	67.83	228
TLHTH PT EVAL/VISIT MOD	TLHTH PT EVAL/VISIT MOD	Medicine	97162	CPT	4401001		Washington Regional Medical Center	outpatient	304	152	Self-Pay	Discounted Cash		69.92	228
TLHTH PT EVAL/VISIT MOD	TLHTH PT EVAL/VISIT MOD	Medicine	97162	CPT	4401001		Washington Regional Medical Center	outpatient	304	152	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	228	69.92	228
TLHTH PT EVAL/VISIT MOD	TLHTH PT EVAL/VISIT MOD	Medicine	97162	CPT	4401001		Washington Regional Medical Center	outpatient	304	152	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	133.76	69.92	228
TLHTH PT EVAL/VISIT MOD	TLHTH PT EVAL/VISIT MOD	Medicine	97162	CPT	4401001		Washington Regional Medical Center	outpatient	304	152	Humana	Medicare Advantage HMO/PPO/PFFS	142.88	69.92	228
TLHTH PT EVAL/VISIT MOD	TLHTH PT EVAL/VISIT MOD	Medicine	97162	CPT	4401001		Washington Regional Medical Center	outpatient	304	152	AmeriHealth Caritas North Carolina	NC Medicaid	106.89	69.92	228
TLHTH PT EVAL/VISIT MOD	TLHTH PT EVAL/VISIT MOD	Medicine	97162	CPT	4401001		Washington Regional Medical Center	outpatient	304	152	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	106.89	69.92	228
TLHTH PT EVAL/VISIT MOD	TLHTH PT EVAL/VISIT MOD	Medicine	97162	CPT	4401001		Washington Regional Medical Center	outpatient	304	152	WellCare of North Carolina	North Carolina Medicaid/CHIP	106.89	69.92	228
TLHTH PT EVAL/VISIT MOD	TLHTH PT EVAL/VISIT MOD	Medicine	97162	CPT	4401001		Washington Regional Medical Center	outpatient	304	152	Healthy Blue / Blue Cross NC	North Carolina Medicaid	106.89	69.92	228
TLHTH PT EVAL/VISIT MOD	TLHTH PT EVAL/VISIT MOD	Medicine	97162	CPT	4401001		Washington Regional Medical Center	outpatient	304	152	Cigna	North Carolina PPO-PPA Direct	69.92	69.92	228
TLHTH PT EVAL/VISIT MOD	TLHTH PT EVAL/VISIT MOD	Medicine	97162	CPT	4401001		Washington Regional Medical Center	outpatient	304	152	Original Medicare	Traditional Medicare Fee-for-Service	142.88	69.92	228
TLHTH ST EVAL ORL SWL FUNC	TLHTH ST EVAL ORL SWL FUNC	Medicine	92610	CPT	4401008		Washington Regional Medical Center	outpatient	318	159	Self-Pay	Discounted Cash		111.81	238.5
TLHTH ST EVAL ORL SWL FUNC	TLHTH ST EVAL ORL SWL FUNC	Medicine	92610	CPT	4401008		Washington Regional Medical Center	outpatient	318	159	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	238.5	111.81	238.5
TLHTH ST EVAL ORL SWL FUNC	TLHTH ST EVAL ORL SWL FUNC	Medicine	92610	CPT	4401008		Washington Regional Medical Center	outpatient	318	159	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	139.92	111.81	238.5
TLHTH ST EVAL ORL SWL FUNC	TLHTH ST EVAL ORL SWL FUNC	Medicine	92610	CPT	4401008		Washington Regional Medical Center	outpatient	318	159	Humana	Medicare Advantage HMO/PPO/PFFS	149.46	111.81	238.5
TLHTH ST EVAL ORL SWL FUNC	TLHTH ST EVAL ORL SWL FUNC	Medicine	92610	CPT	4401008		Washington Regional Medical Center	outpatient	318	159	AmeriHealth Caritas North Carolina	NC Medicaid	111.81	111.81	238.5
TLHTH ST EVAL ORL SWL FUNC	TLHTH ST EVAL ORL SWL FUNC	Medicine	92610	CPT	4401008		Washington Regional Medical Center	outpatient	318	159	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	111.81	111.81	238.5
TLHTH ST EVAL ORL SWL FUNC	TLHTH ST EVAL ORL SWL FUNC	Medicine	92610	CPT	4401008		Washington Regional Medical Center	outpatient	318	159	WellCare of North Carolina	North Carolina Medicaid/CHIP	111.81	111.81	238.5
TLHTH ST EVAL ORL SWL FUNC	TLHTH ST EVAL ORL SWL FUNC	Medicine	92610	CPT	4401008		Washington Regional Medical Center	outpatient	318	159	Healthy Blue / Blue Cross NC	North Carolina Medicaid	111.81	111.81	238.5
TLHTH ST EVAL ORL SWL FUNC	TLHTH ST EVAL ORL SWL FUNC	Medicine	92610	CPT	4401008		Washington Regional Medical Center	outpatient	318	159	Cigna	North Carolina PPO-PPA Direct	134.4	111.81	238.5
TLHTH ST EVAL ORL SWL FUNC	TLHTH ST EVAL ORL SWL FUNC	Medicine	92610	CPT	4401008		Washington Regional Medical Center	outpatient	318	159	Original Medicare	Traditional Medicare Fee-for-Service	149.46	111.81	238.5
TLHTH ST EVAL SPEECH PROD	TLHTH ST EVAL SPEECH PROD	Medicine	92522	CPT	4401007		Washington Regional Medical Center	outpatient	193	96.5	Self-Pay	Discounted Cash		67.86	144.75
TLHTH ST EVAL SPEECH PROD	TLHTH ST EVAL SPEECH PROD	Medicine	92522	CPT	4401007		Washington Regional Medical Center	outpatient	193	96.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	144.75	67.86	144.75
TLHTH ST EVAL SPEECH PROD	TLHTH ST EVAL SPEECH PROD	Medicine	92522	CPT	4401007		Washington Regional Medical Center	outpatient	193	96.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	84.92	67.86	144.75
TLHTH ST EVAL SPEECH PROD	TLHTH ST EVAL SPEECH PROD	Medicine	92522	CPT	4401007		Washington Regional Medical Center	outpatient	193	96.5	Humana	Medicare Advantage HMO/PPO/PFFS	90.71	67.86	144.75
TLHTH ST EVAL SPEECH PROD	TLHTH ST EVAL SPEECH PROD	Medicine	92522	CPT	4401007		Washington Regional Medical Center	outpatient	193	96.5	AmeriHealth Caritas North Carolina	NC Medicaid	67.86	67.86	144.75
TLHTH ST EVAL SPEECH PROD	TLHTH ST EVAL SPEECH PROD	Medicine	92522	CPT	4401007		Washington Regional Medical Center	outpatient	193	96.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	67.86	67.86	144.75
TLHTH ST EVAL SPEECH PROD	TLHTH ST EVAL SPEECH PROD	Medicine	92522	CPT	4401007		Washington Regional Medical Center	outpatient	193	96.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	67.86	67.86	144.75
TLHTH ST EVAL SPEECH PROD	TLHTH ST EVAL SPEECH PROD	Medicine	92522	CPT	4401007		Washington Regional Medical Center	outpatient	193	96.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	67.86	67.86	144.75
TLHTH ST EVAL SPEECH PROD	TLHTH ST EVAL SPEECH PROD	Medicine	92522	CPT	4401007		Washington Regional Medical Center	outpatient	193	96.5	Cigna	North Carolina PPO-PPA Direct	104.21	67.86	144.75
TLHTH ST EVAL SPEECH PROD	TLHTH ST EVAL SPEECH PROD	Medicine	92522	CPT	4401007		Washington Regional Medical Center	outpatient	193	96.5	Original Medicare	Traditional Medicare Fee-for-Service	90.71	67.86	144.75
US CAROTID DUPLEX BILAT	US CAROTID DUPLEX BILAT	Medicine	93880	CPT	2101003		Washington Regional Medical Center	outpatient	1316	658	Self-Pay	Discounted Cash		215.64	987
US CAROTID DUPLEX BILAT	US CAROTID DUPLEX BILAT	Medicine	93880	CPT	2101003		Washington Regional Medical Center	outpatient	1316	658	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	987	215.64	987
US CAROTID DUPLEX BILAT	US CAROTID DUPLEX BILAT	Medicine	93880	CPT	2101003		Washington Regional Medical Center	outpatient	1316	658	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	579.04	215.64	987
US CAROTID DUPLEX BILAT	US CAROTID DUPLEX BILAT	Medicine	93880	CPT	2101003		Washington Regional Medical Center	outpatient	1316	658	Humana	Medicare Advantage HMO/PPO/PFFS	618.52	215.64	987
US CAROTID DUPLEX BILAT	US CAROTID DUPLEX BILAT	Medicine	93880	CPT	2101003		Washington Regional Medical Center	outpatient	1316	658	AmeriHealth Caritas North Carolina	NC Medicaid	462.71	215.64	987
US CAROTID DUPLEX BILAT	US CAROTID DUPLEX BILAT	Medicine	93880	CPT	2101003		Washington Regional Medical Center	outpatient	1316	658	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	462.71	215.64	987
US CAROTID DUPLEX BILAT	US CAROTID DUPLEX BILAT	Medicine	93880	CPT	2101003		Washington Regional Medical Center	outpatient	1316	658	WellCare of North Carolina	North Carolina Medicaid/CHIP	462.71	215.64	987
US CAROTID DUPLEX BILAT	US CAROTID DUPLEX BILAT	Medicine	93880	CPT	2101003		Washington Regional Medical Center	outpatient	1316	658	Healthy Blue / Blue Cross NC	North Carolina Medicaid	462.71	215.64	987
US CAROTID DUPLEX BILAT	US CAROTID DUPLEX BILAT	Medicine	93880	CPT	2101003		Washington Regional Medical Center	outpatient	1316	658	Cigna	North Carolina PPO-PPA Direct	215.64	215.64	987
US CAROTID DUPLEX BILAT	US CAROTID DUPLEX BILAT	Medicine	93880	CPT	2101003		Washington Regional Medical Center	outpatient	1316	658	Original Medicare	Traditional Medicare Fee-for-Service	618.52	215.64	987
US DOPPLER	US DOPPLER	Medicine	93320	CPT	2101062		Washington Regional Medical Center	outpatient	614	307	Self-Pay	Discounted Cash		69.14	460.5
US DOPPLER	US DOPPLER	Medicine	93320	CPT	2101062		Washington Regional Medical Center	outpatient	614	307	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	460.5	69.14	460.5
US DOPPLER	US DOPPLER	Medicine	93320	CPT	2101062		Washington Regional Medical Center	outpatient	614	307	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	270.16	69.14	460.5
US DOPPLER	US DOPPLER	Medicine	93320	CPT	2101062		Washington Regional Medical Center	outpatient	614	307	Humana	Medicare Advantage HMO/PPO/PFFS	288.58	69.14	460.5
US DOPPLER	US DOPPLER	Medicine	93320	CPT	2101062		Washington Regional Medical Center	outpatient	614	307	AmeriHealth Caritas North Carolina	NC Medicaid	215.88	69.14	460.5
US DOPPLER	US DOPPLER	Medicine	93320	CPT	2101062		Washington Regional Medical Center	outpatient	614	307	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	215.88	69.14	460.5
US DOPPLER	US DOPPLER	Medicine	93320	CPT	2101062		Washington Regional Medical Center	outpatient	614	307	WellCare of North Carolina	North Carolina Medicaid/CHIP	215.88	69.14	460.5
US DOPPLER	US DOPPLER	Medicine	93320	CPT	2101062		Washington Regional Medical Center	outpatient	614	307	Healthy Blue / Blue Cross NC	North Carolina Medicaid	215.88	69.14	460.5
US DOPPLER	US DOPPLER	Medicine	93320	CPT	2101062		Washington Regional Medical Center	outpatient	614	307	Cigna	North Carolina PPO-PPA Direct	69.14	69.14	460.5
US DOPPLER	US DOPPLER	Medicine	93320	CPT	2101062		Washington Regional Medical Center	outpatient	614	307	Original Medicare	Traditional Medicare Fee-for-Service	288.58	69.14	460.5
US VEN DOP UE LT	US VEN DOP UE LT	Medicine	93971	CPT	2101130		Washington Regional Medical Center	outpatient	333.57	166.79	Self-Pay	Discounted Cash		117.28	250.18
US VEN DOP UE LT	US VEN DOP UE LT	Medicine	93971	CPT	2101130		Washington Regional Medical Center	outpatient	333.57	166.79	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	250.18	117.28	250.18
US VEN DOP UE LT	US VEN DOP UE LT	Medicine	93971	CPT	2101130		Washington Regional Medical Center	outpatient	333.57	166.79	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	146.77	117.28	250.18
US VEN DOP UE LT	US VEN DOP UE LT	Medicine	93971	CPT	2101130		Washington Regional Medical Center	outpatient	333.57	166.79	Humana	Medicare Advantage HMO/PPO/PFFS	156.78	117.28	250.18
US VEN DOP UE LT	US VEN DOP UE LT	Medicine	93971	CPT	2101130		Washington Regional Medical Center	outpatient	333.57	166.79	AmeriHealth Caritas North Carolina	NC Medicaid	117.28	117.28	250.18
US VEN DOP UE LT	US VEN DOP UE LT	Medicine	93971	CPT	2101130		Washington Regional Medical Center	outpatient	333.57	166.79	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	117.28	117.28	250.18
US VEN DOP UE LT	US VEN DOP UE LT	Medicine	93971	CPT	2101130		Washington Regional Medical Center	outpatient	333.57	166.79	WellCare of North Carolina	North Carolina Medicaid/CHIP	117.28	117.28	250.18
US VEN DOP UE LT	US VEN DOP UE LT	Medicine	93971	CPT	2101130		Washington Regional Medical Center	outpatient	333.57	166.79	Healthy Blue / Blue Cross NC	North Carolina Medicaid	117.28	117.28	250.18
US VEN DOP UE LT	US VEN DOP UE LT	Medicine	93971	CPT	2101130		Washington Regional Medical Center	outpatient	333.57	166.79	Cigna	North Carolina PPO-PPA Direct	139.85	117.28	250.18
US VEN DOP UE LT	US VEN DOP UE LT	Medicine	93971	CPT	2101130		Washington Regional Medical Center	outpatient	333.57	166.79	Original Medicare	Traditional Medicare Fee-for-Service	156.78	117.28	250.18
US VENOUS DOPP LOW EXT LT	US VENOUS DOPP LOW EXT LT	Medicine	93971	CPT	2101096		Washington Regional Medical Center	outpatient	667.14	333.57	Self-Pay	Discounted Cash		139.85	500.36
US VENOUS DOPP LOW EXT LT	US VENOUS DOPP LOW EXT LT	Medicine	93971	CPT	2101096		Washington Regional Medical Center	outpatient	667.14	333.57	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	500.36	139.85	500.36
US VENOUS DOPP LOW EXT LT	US VENOUS DOPP LOW EXT LT	Medicine	93971	CPT	2101096		Washington Regional Medical Center	outpatient	667.14	333.57	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	293.54	139.85	500.36
US VENOUS DOPP LOW EXT LT	US VENOUS DOPP LOW EXT LT	Medicine	93971	CPT	2101096		Washington Regional Medical Center	outpatient	667.14	333.57	Humana	Medicare Advantage HMO/PPO/PFFS	313.56	139.85	500.36
US VENOUS DOPP LOW EXT LT	US VENOUS DOPP LOW EXT LT	Medicine	93971	CPT	2101096		Washington Regional Medical Center	outpatient	667.14	333.57	AmeriHealth Caritas North Carolina	NC Medicaid	234.57	139.85	500.36
US VENOUS DOPP LOW EXT LT	US VENOUS DOPP LOW EXT LT	Medicine	93971	CPT	2101096		Washington Regional Medical Center	outpatient	667.14	333.57	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	234.57	139.85	500.36
US VENOUS DOPP LOW EXT LT	US VENOUS DOPP LOW EXT LT	Medicine	93971	CPT	2101096		Washington Regional Medical Center	outpatient	667.14	333.57	WellCare of North Carolina	North Carolina Medicaid/CHIP	234.57	139.85	500.36
US VENOUS DOPP LOW EXT LT	US VENOUS DOPP LOW EXT LT	Medicine	93971	CPT	2101096		Washington Regional Medical Center	outpatient	667.14	333.57	Healthy Blue / Blue Cross NC	North Carolina Medicaid	234.57	139.85	500.36
US VENOUS DOPP LOW EXT LT	US VENOUS DOPP LOW EXT LT	Medicine	93971	CPT	2101096		Washington Regional Medical Center	outpatient	667.14	333.57	Cigna	North Carolina PPO-PPA Direct	139.85	139.85	500.36
US VENOUS DOPP LOW EXT LT	US VENOUS DOPP LOW EXT LT	Medicine	93971	CPT	2101096		Washington Regional Medical Center	outpatient	667.14	333.57	Original Medicare	Traditional Medicare Fee-for-Service	313.56	139.85	500.36
US VENOUS DOPP LOW EXT RT	US VENOUS DOPP LOW EXT RT	Medicine	93971	CPT	2101097		Washington Regional Medical Center	outpatient	667.14	333.57	Self-Pay	Discounted Cash		139.85	500.36
US VENOUS DOPP LOW EXT RT	US VENOUS DOPP LOW EXT RT	Medicine	93971	CPT	2101097		Washington Regional Medical Center	outpatient	667.14	333.57	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	500.36	139.85	500.36
US VENOUS DOPP LOW EXT RT	US VENOUS DOPP LOW EXT RT	Medicine	93971	CPT	2101097		Washington Regional Medical Center	outpatient	667.14	333.57	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	293.54	139.85	500.36
US VENOUS DOPP LOW EXT RT	US VENOUS DOPP LOW EXT RT	Medicine	93971	CPT	2101097		Washington Regional Medical Center	outpatient	667.14	333.57	Humana	Medicare Advantage HMO/PPO/PFFS	313.56	139.85	500.36
US VENOUS DOPP LOW EXT RT	US VENOUS DOPP LOW EXT RT	Medicine	93971	CPT	2101097		Washington Regional Medical Center	outpatient	667.14	333.57	AmeriHealth Caritas North Carolina	NC Medicaid	234.57	139.85	500.36
US VENOUS DOPP LOW EXT RT	US VENOUS DOPP LOW EXT RT	Medicine	93971	CPT	2101097		Washington Regional Medical Center	outpatient	667.14	333.57	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	234.57	139.85	500.36
US VENOUS DOPP LOW EXT RT	US VENOUS DOPP LOW EXT RT	Medicine	93971	CPT	2101097		Washington Regional Medical Center	outpatient	667.14	333.57	WellCare of North Carolina	North Carolina Medicaid/CHIP	234.57	139.85	500.36
US VENOUS DOPP LOW EXT RT	US VENOUS DOPP LOW EXT RT	Medicine	93971	CPT	2101097		Washington Regional Medical Center	outpatient	667.14	333.57	Healthy Blue / Blue Cross NC	North Carolina Medicaid	234.57	139.85	500.36
US VENOUS DOPP LOW EXT RT	US VENOUS DOPP LOW EXT RT	Medicine	93971	CPT	2101097		Washington Regional Medical Center	outpatient	667.14	333.57	Cigna	North Carolina PPO-PPA Direct	139.85	139.85	500.36
US VENOUS DOPP LOW EXT RT	US VENOUS DOPP LOW EXT RT	Medicine	93971	CPT	2101097		Washington Regional Medical Center	outpatient	667.14	333.57	Original Medicare	Traditional Medicare Fee-for-Service	313.56	139.85	500.36
US VENOUS DOPPLER UPPER EXT RT	US VENOUS DOPPLER UPPER EXT RT	Medicine	93971	CPT	2101076		Washington Regional Medical Center	outpatient	667.14	333.57	Self-Pay	Discounted Cash		139.85	500.36
US VENOUS DOPPLER UPPER EXT RT	US VENOUS DOPPLER UPPER EXT RT	Medicine	93971	CPT	2101076		Washington Regional Medical Center	outpatient	667.14	333.57	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	500.36	139.85	500.36
US VENOUS DOPPLER UPPER EXT RT	US VENOUS DOPPLER UPPER EXT RT	Medicine	93971	CPT	2101076		Washington Regional Medical Center	outpatient	667.14	333.57	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	293.54	139.85	500.36
US VENOUS DOPPLER UPPER EXT RT	US VENOUS DOPPLER UPPER EXT RT	Medicine	93971	CPT	2101076		Washington Regional Medical Center	outpatient	667.14	333.57	Humana	Medicare Advantage HMO/PPO/PFFS	313.56	139.85	500.36
US VENOUS DOPPLER UPPER EXT RT	US VENOUS DOPPLER UPPER EXT RT	Medicine	93971	CPT	2101076		Washington Regional Medical Center	outpatient	667.14	333.57	AmeriHealth Caritas North Carolina	NC Medicaid	234.57	139.85	500.36
US VENOUS DOPPLER UPPER EXT RT	US VENOUS DOPPLER UPPER EXT RT	Medicine	93971	CPT	2101076		Washington Regional Medical Center	outpatient	667.14	333.57	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	234.57	139.85	500.36
US VENOUS DOPPLER UPPER EXT RT	US VENOUS DOPPLER UPPER EXT RT	Medicine	93971	CPT	2101076		Washington Regional Medical Center	outpatient	667.14	333.57	WellCare of North Carolina	North Carolina Medicaid/CHIP	234.57	139.85	500.36
US VENOUS DOPPLER UPPER EXT RT	US VENOUS DOPPLER UPPER EXT RT	Medicine	93971	CPT	2101076		Washington Regional Medical Center	outpatient	667.14	333.57	Healthy Blue / Blue Cross NC	North Carolina Medicaid	234.57	139.85	500.36
US VENOUS DOPPLER UPPER EXT RT	US VENOUS DOPPLER UPPER EXT RT	Medicine	93971	CPT	2101076		Washington Regional Medical Center	outpatient	667.14	333.57	Cigna	North Carolina PPO-PPA Direct	139.85	139.85	500.36
US VENOUS DOPPLER UPPER EXT RT	US VENOUS DOPPLER UPPER EXT RT	Medicine	93971	CPT	2101076		Washington Regional Medical Center	outpatient	667.14	333.57	Original Medicare	Traditional Medicare Fee-for-Service	313.56	139.85	500.36
VENT SUBSEQUENT DAY	VENT SUBSEQUENT DAY	Medicine	94003	CPT	4001034		Washington Regional Medical Center	outpatient	260	130	Self-Pay	Discounted Cash		65.6	195
VENT SUBSEQUENT DAY	VENT SUBSEQUENT DAY	Medicine	94003	CPT	4001034		Washington Regional Medical Center	outpatient	260	130	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	195	65.6	195
VENT SUBSEQUENT DAY	VENT SUBSEQUENT DAY	Medicine	94003	CPT	4001034		Washington Regional Medical Center	outpatient	260	130	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	114.4	65.6	195
VENT SUBSEQUENT DAY	VENT SUBSEQUENT DAY	Medicine	94003	CPT	4001034		Washington Regional Medical Center	outpatient	260	130	Humana	Medicare Advantage HMO/PPO/PFFS	122.2	65.6	195
VENT SUBSEQUENT DAY	VENT SUBSEQUENT DAY	Medicine	94003	CPT	4001034		Washington Regional Medical Center	outpatient	260	130	AmeriHealth Caritas North Carolina	NC Medicaid	91.42	65.6	195
VENT SUBSEQUENT DAY	VENT SUBSEQUENT DAY	Medicine	94003	CPT	4001034		Washington Regional Medical Center	outpatient	260	130	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	91.42	65.6	195
VENT SUBSEQUENT DAY	VENT SUBSEQUENT DAY	Medicine	94003	CPT	4001034		Washington Regional Medical Center	outpatient	260	130	WellCare of North Carolina	North Carolina Medicaid/CHIP	91.42	65.6	195
VENT SUBSEQUENT DAY	VENT SUBSEQUENT DAY	Medicine	94003	CPT	4001034		Washington Regional Medical Center	outpatient	260	130	Healthy Blue / Blue Cross NC	North Carolina Medicaid	91.42	65.6	195
VENT SUBSEQUENT DAY	VENT SUBSEQUENT DAY	Medicine	94003	CPT	4001034		Washington Regional Medical Center	outpatient	260	130	Cigna	North Carolina PPO-PPA Direct	65.6	65.6	195
VENT SUBSEQUENT DAY	VENT SUBSEQUENT DAY	Medicine	94003	CPT	4001034		Washington Regional Medical Center	outpatient	260	130	Original Medicare	Traditional Medicare Fee-for-Service	122.2	65.6	195
Biopsy of prostate gland	Biopsy of prostate gland	Medicine & Surgery	55700	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Cardiac valve/major cardiothoracic procedure with catheterization and MCC	Cardiac valve/major cardiothoracic procedure with catheterization and MCC	Medicine & Surgery	216	MS-DRG			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Cataract removal with insertion of lens	Cataract removal with insertion of lens	Medicine & Surgery	66984	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Cervical spinal fusion without CC/MCC	Cervical spinal fusion without CC/MCC	Medicine & Surgery	473	MS-DRG			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Colonoscopy with biopsy	Colonoscopy with biopsy	Medicine & Surgery	45380	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Colonoscopy with removal of polyps/growths	REMOVAL FOREIGN BODY RECTUM	Medicine & Surgery	45385	CPT	6001585		Washington Regional Medical Center	outpatient	2431.44	1215.72	Self-Pay	Discounted Cash		338.65	1823.58
Colonoscopy with removal of polyps/growths	REMOVAL FOREIGN BODY RECTUM	Medicine & Surgery	45385	CPT	6001585		Washington Regional Medical Center	outpatient	2431.44	1215.72	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1823.58	338.65	1823.58
Colonoscopy with removal of polyps/growths	REMOVAL FOREIGN BODY RECTUM	Medicine & Surgery	45385	CPT	6001585		Washington Regional Medical Center	outpatient	2431.44	1215.72	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	1069.83	338.65	1823.58
Colonoscopy with removal of polyps/growths	REMOVAL FOREIGN BODY RECTUM	Medicine & Surgery	45385	CPT	6001585		Washington Regional Medical Center	outpatient	2431.44	1215.72	Humana	Medicare Advantage HMO/PPO/PFFS	1142.78	338.65	1823.58
Colonoscopy with removal of polyps/growths	REMOVAL FOREIGN BODY RECTUM	Medicine & Surgery	45385	CPT	6001585		Washington Regional Medical Center	outpatient	2431.44	1215.72	AmeriHealth Caritas North Carolina	NC Medicaid	854.89	338.65	1823.58
Colonoscopy with removal of polyps/growths	REMOVAL FOREIGN BODY RECTUM	Medicine & Surgery	45385	CPT	6001585		Washington Regional Medical Center	outpatient	2431.44	1215.72	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	854.89	338.65	1823.58
Colonoscopy with removal of polyps/growths	REMOVAL FOREIGN BODY RECTUM	Medicine & Surgery	45385	CPT	6001585		Washington Regional Medical Center	outpatient	2431.44	1215.72	WellCare of North Carolina	North Carolina Medicaid/CHIP	854.89	338.65	1823.58
Colonoscopy with removal of polyps/growths	REMOVAL FOREIGN BODY RECTUM	Medicine & Surgery	45385	CPT	6001585		Washington Regional Medical Center	outpatient	2431.44	1215.72	Healthy Blue / Blue Cross NC	North Carolina Medicaid	854.89	338.65	1823.58
Colonoscopy with removal of polyps/growths	REMOVAL FOREIGN BODY RECTUM	Medicine & Surgery	45385	CPT	6001585		Washington Regional Medical Center	outpatient	2431.44	1215.72	Cigna	North Carolina PPO-PPA Direct	338.65	338.65	1823.58
Colonoscopy with removal of polyps/growths	REMOVAL FOREIGN BODY RECTUM	Medicine & Surgery	45385	CPT	6001585		Washington Regional Medical Center	outpatient	2431.44	1215.72	Original Medicare	Traditional Medicare Fee-for-Service	1142.78	338.65	1823.58
Diagnostic colonoscopy	Diagnostic colonoscopy	Medicine & Surgery	45378	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Diagnostic upper GI endoscopy	Diagnostic upper GI endoscopy	Medicine & Surgery	43235	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Electrocardiogram, routine, with interpretation and report	Electrocardiogram, routine, with interpretation and report	Medicine & Surgery	93000	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Insertion of catheter into left heart for diagnosis	Insertion of catheter into left heart for diagnosis	Medicine & Surgery	93452	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Laparoscopic prostatectomy with lymph nodes	Laparoscopic prostatectomy with lymph nodes	Medicine & Surgery	55866	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Laparoscopic removal of gallbladder	Laparoscopic removal of gallbladder	Medicine & Surgery	47562	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Laser removal of recurring cataract in lens capsule	Laser removal of recurring cataract in lens capsule	Medicine & Surgery	66821	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Lower large bowel endoscopic ultrasound	Lower large bowel endoscopic ultrasound	Medicine & Surgery	45391	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Lumbar/sacral nerve-root injection using imaging guidance	Lumbar/sacral nerve-root injection using imaging guidance	Medicine & Surgery	64483	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Lumbar/sacral spinal injection using imaging guidance	Lumbar/sacral spinal injection using imaging guidance	Medicine & Surgery	62322 or 62323	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Major joint replacement or reattachment of lower extremity without MCC	Major joint replacement or reattachment of lower extremity without MCC	Medicine & Surgery	470	MS-DRG			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Physical therapy, therapeutic exercise	PT THERAPY EXER/15 MIN	Medicine & Surgery	97110	CPT	4101023		Washington Regional Medical Center	outpatient	140	70	Self-Pay	Discounted Cash		22.95	105
Physical therapy, therapeutic exercise	PT THERAPY EXER/15 MIN	Medicine & Surgery	97110	CPT	4101023		Washington Regional Medical Center	outpatient	140	70	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	105	22.95	105
Physical therapy, therapeutic exercise	PT THERAPY EXER/15 MIN	Medicine & Surgery	97110	CPT	4101023		Washington Regional Medical Center	outpatient	140	70	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	61.6	22.95	105
Physical therapy, therapeutic exercise	PT THERAPY EXER/15 MIN	Medicine & Surgery	97110	CPT	4101023		Washington Regional Medical Center	outpatient	140	70	Humana	Medicare Advantage HMO/PPO/PFFS	65.8	22.95	105
Physical therapy, therapeutic exercise	PT THERAPY EXER/15 MIN	Medicine & Surgery	97110	CPT	4101023		Washington Regional Medical Center	outpatient	140	70	AmeriHealth Caritas North Carolina	NC Medicaid	49.22	22.95	105
Physical therapy, therapeutic exercise	PT THERAPY EXER/15 MIN	Medicine & Surgery	97110	CPT	4101023		Washington Regional Medical Center	outpatient	140	70	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	49.22	22.95	105
Physical therapy, therapeutic exercise	PT THERAPY EXER/15 MIN	Medicine & Surgery	97110	CPT	4101023		Washington Regional Medical Center	outpatient	140	70	WellCare of North Carolina	North Carolina Medicaid/CHIP	49.22	22.95	105
Physical therapy, therapeutic exercise	PT THERAPY EXER/15 MIN	Medicine & Surgery	97110	CPT	4101023		Washington Regional Medical Center	outpatient	140	70	Healthy Blue / Blue Cross NC	North Carolina Medicaid	49.22	22.95	105
Physical therapy, therapeutic exercise	PT THERAPY EXER/15 MIN	Medicine & Surgery	97110	CPT	4101023		Washington Regional Medical Center	outpatient	140	70	Cigna	North Carolina PPO-PPA Direct	22.95	22.95	105
Physical therapy, therapeutic exercise	PT THERAPY EXER/15 MIN	Medicine & Surgery	97110	CPT	4101023		Washington Regional Medical Center	outpatient	140	70	Original Medicare	Traditional Medicare Fee-for-Service	65.8	22.95	105
Physical therapy, therapeutic exercise	OT THERAPY EXER/15 MIN	Medicine & Surgery	97110	CPT	4201009		Washington Regional Medical Center	outpatient	140	70	Self-Pay	Discounted Cash		22.95	105
Physical therapy, therapeutic exercise	OT THERAPY EXER/15 MIN	Medicine & Surgery	97110	CPT	4201009		Washington Regional Medical Center	outpatient	140	70	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	105	22.95	105
Physical therapy, therapeutic exercise	OT THERAPY EXER/15 MIN	Medicine & Surgery	97110	CPT	4201009		Washington Regional Medical Center	outpatient	140	70	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	61.6	22.95	105
Physical therapy, therapeutic exercise	OT THERAPY EXER/15 MIN	Medicine & Surgery	97110	CPT	4201009		Washington Regional Medical Center	outpatient	140	70	Humana	Medicare Advantage HMO/PPO/PFFS	65.8	22.95	105
Physical therapy, therapeutic exercise	OT THERAPY EXER/15 MIN	Medicine & Surgery	97110	CPT	4201009		Washington Regional Medical Center	outpatient	140	70	AmeriHealth Caritas North Carolina	NC Medicaid	49.22	22.95	105
Physical therapy, therapeutic exercise	OT THERAPY EXER/15 MIN	Medicine & Surgery	97110	CPT	4201009		Washington Regional Medical Center	outpatient	140	70	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	49.22	22.95	105
Physical therapy, therapeutic exercise	OT THERAPY EXER/15 MIN	Medicine & Surgery	97110	CPT	4201009		Washington Regional Medical Center	outpatient	140	70	WellCare of North Carolina	North Carolina Medicaid/CHIP	49.22	22.95	105
Physical therapy, therapeutic exercise	OT THERAPY EXER/15 MIN	Medicine & Surgery	97110	CPT	4201009		Washington Regional Medical Center	outpatient	140	70	Healthy Blue / Blue Cross NC	North Carolina Medicaid	49.22	22.95	105
Physical therapy, therapeutic exercise	OT THERAPY EXER/15 MIN	Medicine & Surgery	97110	CPT	4201009		Washington Regional Medical Center	outpatient	140	70	Cigna	North Carolina PPO-PPA Direct	22.95	22.95	105
Physical therapy, therapeutic exercise	OT THERAPY EXER/15 MIN	Medicine & Surgery	97110	CPT	4201009		Washington Regional Medical Center	outpatient	140	70	Original Medicare	Traditional Medicare Fee-for-Service	65.8	22.95	105
Physical therapy, therapeutic exercise	97110-OCC THER THEREX 15M	Medicine & Surgery	97110	CPT	8010294		Washington Regional Medical Center	outpatient	140	70	Self-Pay	Discounted Cash		22.95	105
Physical therapy, therapeutic exercise	97110-OCC THER THEREX 15M	Medicine & Surgery	97110	CPT	8010294		Washington Regional Medical Center	outpatient	140	70	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	105	22.95	105
Physical therapy, therapeutic exercise	97110-OCC THER THEREX 15M	Medicine & Surgery	97110	CPT	8010294		Washington Regional Medical Center	outpatient	140	70	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	61.6	22.95	105
Physical therapy, therapeutic exercise	97110-OCC THER THEREX 15M	Medicine & Surgery	97110	CPT	8010294		Washington Regional Medical Center	outpatient	140	70	Humana	Medicare Advantage HMO/PPO/PFFS	65.8	22.95	105
Physical therapy, therapeutic exercise	97110-OCC THER THEREX 15M	Medicine & Surgery	97110	CPT	8010294		Washington Regional Medical Center	outpatient	140	70	AmeriHealth Caritas North Carolina	NC Medicaid	49.22	22.95	105
Physical therapy, therapeutic exercise	97110-OCC THER THEREX 15M	Medicine & Surgery	97110	CPT	8010294		Washington Regional Medical Center	outpatient	140	70	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	49.22	22.95	105
Physical therapy, therapeutic exercise	97110-OCC THER THEREX 15M	Medicine & Surgery	97110	CPT	8010294		Washington Regional Medical Center	outpatient	140	70	WellCare of North Carolina	North Carolina Medicaid/CHIP	49.22	22.95	105
Physical therapy, therapeutic exercise	97110-OCC THER THEREX 15M	Medicine & Surgery	97110	CPT	8010294		Washington Regional Medical Center	outpatient	140	70	Healthy Blue / Blue Cross NC	North Carolina Medicaid	49.22	22.95	105
Physical therapy, therapeutic exercise	97110-OCC THER THEREX 15M	Medicine & Surgery	97110	CPT	8010294		Washington Regional Medical Center	outpatient	140	70	Cigna	North Carolina PPO-PPA Direct	22.95	22.95	105
Physical therapy, therapeutic exercise	97110-OCC THER THEREX 15M	Medicine & Surgery	97110	CPT	8010294		Washington Regional Medical Center	outpatient	140	70	Original Medicare	Traditional Medicare Fee-for-Service	65.8	22.95	105
Physical therapy, therapeutic exercise	97110-PHYS THER THEREX 15 MIN	Medicine & Surgery	97110	CPT	8010397		Washington Regional Medical Center	outpatient	140	70	Self-Pay	Discounted Cash		22.95	105
Physical therapy, therapeutic exercise	97110-PHYS THER THEREX 15 MIN	Medicine & Surgery	97110	CPT	8010397		Washington Regional Medical Center	outpatient	140	70	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	105	22.95	105
Physical therapy, therapeutic exercise	97110-PHYS THER THEREX 15 MIN	Medicine & Surgery	97110	CPT	8010397		Washington Regional Medical Center	outpatient	140	70	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	61.6	22.95	105
Physical therapy, therapeutic exercise	97110-PHYS THER THEREX 15 MIN	Medicine & Surgery	97110	CPT	8010397		Washington Regional Medical Center	outpatient	140	70	Humana	Medicare Advantage HMO/PPO/PFFS	65.8	22.95	105
Physical therapy, therapeutic exercise	97110-PHYS THER THEREX 15 MIN	Medicine & Surgery	97110	CPT	8010397		Washington Regional Medical Center	outpatient	140	70	AmeriHealth Caritas North Carolina	NC Medicaid	49.22	22.95	105
Physical therapy, therapeutic exercise	97110-PHYS THER THEREX 15 MIN	Medicine & Surgery	97110	CPT	8010397		Washington Regional Medical Center	outpatient	140	70	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	49.22	22.95	105
Physical therapy, therapeutic exercise	97110-PHYS THER THEREX 15 MIN	Medicine & Surgery	97110	CPT	8010397		Washington Regional Medical Center	outpatient	140	70	WellCare of North Carolina	North Carolina Medicaid/CHIP	49.22	22.95	105
Physical therapy, therapeutic exercise	97110-PHYS THER THEREX 15 MIN	Medicine & Surgery	97110	CPT	8010397		Washington Regional Medical Center	outpatient	140	70	Healthy Blue / Blue Cross NC	North Carolina Medicaid	49.22	22.95	105
Physical therapy, therapeutic exercise	97110-PHYS THER THEREX 15 MIN	Medicine & Surgery	97110	CPT	8010397		Washington Regional Medical Center	outpatient	140	70	Cigna	North Carolina PPO-PPA Direct	22.95	22.95	105
Physical therapy, therapeutic exercise	97110-PHYS THER THEREX 15 MIN	Medicine & Surgery	97110	CPT	8010397		Washington Regional Medical Center	outpatient	140	70	Original Medicare	Traditional Medicare Fee-for-Service	65.8	22.95	105
Removal of one knee cartilage using an endoscope	Arthro Knee w/Mnsct m/a 29881	Medicine & Surgery	29881	CPT	2726699		Washington Regional Medical Center	outpatient	117	58.5	Self-Pay	Discounted Cash		41.14	683.94
Removal of one knee cartilage using an endoscope	Arthro Knee w/Mnsct m/a 29881	Medicine & Surgery	29881	CPT	2726699		Washington Regional Medical Center	outpatient	117	58.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	87.75	41.14	683.94
Removal of one knee cartilage using an endoscope	Arthro Knee w/Mnsct m/a 29881	Medicine & Surgery	29881	CPT	2726699		Washington Regional Medical Center	outpatient	117	58.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	51.48	41.14	683.94
Removal of one knee cartilage using an endoscope	Arthro Knee w/Mnsct m/a 29881	Medicine & Surgery	29881	CPT	2726699		Washington Regional Medical Center	outpatient	117	58.5	Humana	Medicare Advantage HMO/PPO/PFFS	54.99	41.14	683.94
Removal of one knee cartilage using an endoscope	Arthro Knee w/Mnsct m/a 29881	Medicine & Surgery	29881	CPT	2726699		Washington Regional Medical Center	outpatient	117	58.5	AmeriHealth Caritas North Carolina	NC Medicaid	41.14	41.14	683.94
Removal of one knee cartilage using an endoscope	Arthro Knee w/Mnsct m/a 29881	Medicine & Surgery	29881	CPT	2726699		Washington Regional Medical Center	outpatient	117	58.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	41.14	41.14	683.94
Removal of one knee cartilage using an endoscope	Arthro Knee w/Mnsct m/a 29881	Medicine & Surgery	29881	CPT	2726699		Washington Regional Medical Center	outpatient	117	58.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	41.14	41.14	683.94
Removal of one knee cartilage using an endoscope	Arthro Knee w/Mnsct m/a 29881	Medicine & Surgery	29881	CPT	2726699		Washington Regional Medical Center	outpatient	117	58.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	41.14	41.14	683.94
Removal of one knee cartilage using an endoscope	Arthro Knee w/Mnsct m/a 29881	Medicine & Surgery	29881	CPT	2726699		Washington Regional Medical Center	outpatient	117	58.5	Cigna	North Carolina PPO-PPA Direct	683.94	41.14	683.94
Removal of one knee cartilage using an endoscope	Arthro Knee w/Mnsct m/a 29881	Medicine & Surgery	29881	CPT	2726699		Washington Regional Medical Center	outpatient	117	58.5	Original Medicare	Traditional Medicare Fee-for-Service	54.99	41.14	683.94
Removal of one or more breast growths, open procedure	Removal of one or more breast growths, open procedure	Medicine & Surgery	19120	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Removal of tonsils and adenoid glands, patient under age 12	Removal of tonsils and adenoid glands, patient under age 12	Medicine & Surgery	42820	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Repair of groin hernia, age 5 or older	Repair of groin hernia, age 5 or older	Medicine & Surgery	49505	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Routine obstetric care for cesarean delivery	Routine obstetric care for cesarean delivery	Medicine & Surgery	59510	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Routine obstetric care for vaginal delivery	Routine obstetric care for vaginal delivery	Medicine & Surgery	59400	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Routine obstetric care for vaginal delivery after prior cesarean	Routine obstetric care for vaginal delivery after prior cesarean	Medicine & Surgery	59610	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Shaving of shoulder bone using an endoscope	Arthro Shldr Dcmp Lig rl 29826	Medicine & Surgery	29826	CPT	2726684		Washington Regional Medical Center	outpatient	117	58.5	Self-Pay	Discounted Cash		41.14	769.96
Shaving of shoulder bone using an endoscope	Arthro Shldr Dcmp Lig rl 29826	Medicine & Surgery	29826	CPT	2726684		Washington Regional Medical Center	outpatient	117	58.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	87.75	41.14	769.96
Shaving of shoulder bone using an endoscope	Arthro Shldr Dcmp Lig rl 29826	Medicine & Surgery	29826	CPT	2726684		Washington Regional Medical Center	outpatient	117	58.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	51.48	41.14	769.96
Shaving of shoulder bone using an endoscope	Arthro Shldr Dcmp Lig rl 29826	Medicine & Surgery	29826	CPT	2726684		Washington Regional Medical Center	outpatient	117	58.5	Humana	Medicare Advantage HMO/PPO/PFFS	54.99	41.14	769.96
Shaving of shoulder bone using an endoscope	Arthro Shldr Dcmp Lig rl 29826	Medicine & Surgery	29826	CPT	2726684		Washington Regional Medical Center	outpatient	117	58.5	AmeriHealth Caritas North Carolina	NC Medicaid	41.14	41.14	769.96
Shaving of shoulder bone using an endoscope	Arthro Shldr Dcmp Lig rl 29826	Medicine & Surgery	29826	CPT	2726684		Washington Regional Medical Center	outpatient	117	58.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	41.14	41.14	769.96
Shaving of shoulder bone using an endoscope	Arthro Shldr Dcmp Lig rl 29826	Medicine & Surgery	29826	CPT	2726684		Washington Regional Medical Center	outpatient	117	58.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	41.14	41.14	769.96
Shaving of shoulder bone using an endoscope	Arthro Shldr Dcmp Lig rl 29826	Medicine & Surgery	29826	CPT	2726684		Washington Regional Medical Center	outpatient	117	58.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	41.14	41.14	769.96
Shaving of shoulder bone using an endoscope	Arthro Shldr Dcmp Lig rl 29826	Medicine & Surgery	29826	CPT	2726684		Washington Regional Medical Center	outpatient	117	58.5	Cigna	North Carolina PPO-PPA Direct	769.96	41.14	769.96
Shaving of shoulder bone using an endoscope	Arthro Shldr Dcmp Lig rl 29826	Medicine & Surgery	29826	CPT	2726684		Washington Regional Medical Center	outpatient	117	58.5	Original Medicare	Traditional Medicare Fee-for-Service	54.99	41.14	769.96
Sleep study	Sleep study	Medicine & Surgery	95810	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Spinal fusion except cervical without MCC	Spinal fusion except cervical without MCC	Medicine & Surgery	460	MS-DRG			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Upper GI endoscopy with biopsy	Upper GI endoscopy with biopsy	Medicine & Surgery	43239	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Uterine/adnexa procedures for non-malignancy without CC/MCC	Uterine/adnexa procedures for non-malignancy without CC/MCC	Medicine & Surgery	743	MS-DRG			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
Abdominal ultrasound of pregnant uterus (14 weeks or later), single/first fetus	US OB FETAL > 14 WEEKS	Radiology	76805	CPT	2101051		Washington Regional Medical Center	outpatient	762	381	Self-Pay	Discounted Cash		84.18	571.5
Abdominal ultrasound of pregnant uterus (14 weeks or later), single/first fetus	US OB FETAL > 14 WEEKS	Radiology	76805	CPT	2101051		Washington Regional Medical Center	outpatient	762	381	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	571.5	84.18	571.5
Abdominal ultrasound of pregnant uterus (14 weeks or later), single/first fetus	US OB FETAL > 14 WEEKS	Radiology	76805	CPT	2101051		Washington Regional Medical Center	outpatient	762	381	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	335.28	84.18	571.5
Abdominal ultrasound of pregnant uterus (14 weeks or later), single/first fetus	US OB FETAL > 14 WEEKS	Radiology	76805	CPT	2101051		Washington Regional Medical Center	outpatient	762	381	Humana	Medicare Advantage HMO/PPO/PFFS	358.14	84.18	571.5
Abdominal ultrasound of pregnant uterus (14 weeks or later), single/first fetus	US OB FETAL > 14 WEEKS	Radiology	76805	CPT	2101051		Washington Regional Medical Center	outpatient	762	381	AmeriHealth Caritas North Carolina	NC Medicaid	267.92	84.18	571.5
Abdominal ultrasound of pregnant uterus (14 weeks or later), single/first fetus	US OB FETAL > 14 WEEKS	Radiology	76805	CPT	2101051		Washington Regional Medical Center	outpatient	762	381	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	267.92	84.18	571.5
Abdominal ultrasound of pregnant uterus (14 weeks or later), single/first fetus	US OB FETAL > 14 WEEKS	Radiology	76805	CPT	2101051		Washington Regional Medical Center	outpatient	762	381	WellCare of North Carolina	North Carolina Medicaid/CHIP	267.92	84.18	571.5
Abdominal ultrasound of pregnant uterus (14 weeks or later), single/first fetus	US OB FETAL > 14 WEEKS	Radiology	76805	CPT	2101051		Washington Regional Medical Center	outpatient	762	381	Healthy Blue / Blue Cross NC	North Carolina Medicaid	267.92	84.18	571.5
Abdominal ultrasound of pregnant uterus (14 weeks or later), single/first fetus	US OB FETAL > 14 WEEKS	Radiology	76805	CPT	2101051		Washington Regional Medical Center	outpatient	762	381	Cigna	North Carolina PPO-PPA Direct	84.18	84.18	571.5
Abdominal ultrasound of pregnant uterus (14 weeks or later), single/first fetus	US OB FETAL > 14 WEEKS	Radiology	76805	CPT	2101051		Washington Regional Medical Center	outpatient	762	381	Original Medicare	Traditional Medicare Fee-for-Service	358.14	84.18	571.5
Abdominal ultrasound of pregnant uterus (14 weeks or later), single/first fetus	Ob Us +/= 14 WksOneFetus76805	Radiology	76805	CPT	2727327		Washington Regional Medical Center	outpatient	672	336	Self-Pay	Discounted Cash		84.18	504
Abdominal ultrasound of pregnant uterus (14 weeks or later), single/first fetus	Ob Us +/= 14 WksOneFetus76805	Radiology	76805	CPT	2727327		Washington Regional Medical Center	outpatient	672	336	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	504	84.18	504
Abdominal ultrasound of pregnant uterus (14 weeks or later), single/first fetus	Ob Us +/= 14 WksOneFetus76805	Radiology	76805	CPT	2727327		Washington Regional Medical Center	outpatient	672	336	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	295.68	84.18	504
Abdominal ultrasound of pregnant uterus (14 weeks or later), single/first fetus	Ob Us +/= 14 WksOneFetus76805	Radiology	76805	CPT	2727327		Washington Regional Medical Center	outpatient	672	336	Humana	Medicare Advantage HMO/PPO/PFFS	315.84	84.18	504
Abdominal ultrasound of pregnant uterus (14 weeks or later), single/first fetus	Ob Us +/= 14 WksOneFetus76805	Radiology	76805	CPT	2727327		Washington Regional Medical Center	outpatient	672	336	AmeriHealth Caritas North Carolina	NC Medicaid	236.28	84.18	504
Abdominal ultrasound of pregnant uterus (14 weeks or later), single/first fetus	Ob Us +/= 14 WksOneFetus76805	Radiology	76805	CPT	2727327		Washington Regional Medical Center	outpatient	672	336	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	236.28	84.18	504
Abdominal ultrasound of pregnant uterus (14 weeks or later), single/first fetus	Ob Us +/= 14 WksOneFetus76805	Radiology	76805	CPT	2727327		Washington Regional Medical Center	outpatient	672	336	WellCare of North Carolina	North Carolina Medicaid/CHIP	236.28	84.18	504
Abdominal ultrasound of pregnant uterus (14 weeks or later), single/first fetus	Ob Us +/= 14 WksOneFetus76805	Radiology	76805	CPT	2727327		Washington Regional Medical Center	outpatient	672	336	Healthy Blue / Blue Cross NC	North Carolina Medicaid	236.28	84.18	504
Abdominal ultrasound of pregnant uterus (14 weeks or later), single/first fetus	Ob Us +/= 14 WksOneFetus76805	Radiology	76805	CPT	2727327		Washington Regional Medical Center	outpatient	672	336	Cigna	North Carolina PPO-PPA Direct	84.18	84.18	504
Abdominal ultrasound of pregnant uterus (14 weeks or later), single/first fetus	Ob Us +/= 14 WksOneFetus76805	Radiology	76805	CPT	2727327		Washington Regional Medical Center	outpatient	672	336	Original Medicare	Traditional Medicare Fee-for-Service	315.84	84.18	504
ANKLE, 2 VIEWS LT	ANKLE, 2 VIEWS LT	Radiology	73600	CPT	2001020		Washington Regional Medical Center	outpatient	216	108	Self-Pay	Discounted Cash		19.43	162
ANKLE, 2 VIEWS LT	ANKLE, 2 VIEWS LT	Radiology	73600	CPT	2001020		Washington Regional Medical Center	outpatient	216	108	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	162	19.43	162
ANKLE, 2 VIEWS LT	ANKLE, 2 VIEWS LT	Radiology	73600	CPT	2001020		Washington Regional Medical Center	outpatient	216	108	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	95.04	19.43	162
ANKLE, 2 VIEWS LT	ANKLE, 2 VIEWS LT	Radiology	73600	CPT	2001020		Washington Regional Medical Center	outpatient	216	108	Humana	Medicare Advantage HMO/PPO/PFFS	101.52	19.43	162
ANKLE, 2 VIEWS LT	ANKLE, 2 VIEWS LT	Radiology	73600	CPT	2001020		Washington Regional Medical Center	outpatient	216	108	AmeriHealth Caritas North Carolina	NC Medicaid	75.95	19.43	162
ANKLE, 2 VIEWS LT	ANKLE, 2 VIEWS LT	Radiology	73600	CPT	2001020		Washington Regional Medical Center	outpatient	216	108	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	75.95	19.43	162
ANKLE, 2 VIEWS LT	ANKLE, 2 VIEWS LT	Radiology	73600	CPT	2001020		Washington Regional Medical Center	outpatient	216	108	WellCare of North Carolina	North Carolina Medicaid/CHIP	75.95	19.43	162
ANKLE, 2 VIEWS LT	ANKLE, 2 VIEWS LT	Radiology	73600	CPT	2001020		Washington Regional Medical Center	outpatient	216	108	Healthy Blue / Blue Cross NC	North Carolina Medicaid	75.95	19.43	162
ANKLE, 2 VIEWS LT	ANKLE, 2 VIEWS LT	Radiology	73600	CPT	2001020		Washington Regional Medical Center	outpatient	216	108	Cigna	North Carolina PPO-PPA Direct	19.43	19.43	162
ANKLE, 2 VIEWS LT	ANKLE, 2 VIEWS LT	Radiology	73600	CPT	2001020		Washington Regional Medical Center	outpatient	216	108	Original Medicare	Traditional Medicare Fee-for-Service	101.52	19.43	162
ANKLE, 2 VIEWS RT	ANKLE, 2 VIEWS RT	Radiology	73600	CPT	2001021		Washington Regional Medical Center	outpatient	216	108	Self-Pay	Discounted Cash		19.43	162
ANKLE, 2 VIEWS RT	ANKLE, 2 VIEWS RT	Radiology	73600	CPT	2001021		Washington Regional Medical Center	outpatient	216	108	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	162	19.43	162
ANKLE, 2 VIEWS RT	ANKLE, 2 VIEWS RT	Radiology	73600	CPT	2001021		Washington Regional Medical Center	outpatient	216	108	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	95.04	19.43	162
ANKLE, 2 VIEWS RT	ANKLE, 2 VIEWS RT	Radiology	73600	CPT	2001021		Washington Regional Medical Center	outpatient	216	108	Humana	Medicare Advantage HMO/PPO/PFFS	101.52	19.43	162
ANKLE, 2 VIEWS RT	ANKLE, 2 VIEWS RT	Radiology	73600	CPT	2001021		Washington Regional Medical Center	outpatient	216	108	AmeriHealth Caritas North Carolina	NC Medicaid	75.95	19.43	162
ANKLE, 2 VIEWS RT	ANKLE, 2 VIEWS RT	Radiology	73600	CPT	2001021		Washington Regional Medical Center	outpatient	216	108	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	75.95	19.43	162
ANKLE, 2 VIEWS RT	ANKLE, 2 VIEWS RT	Radiology	73600	CPT	2001021		Washington Regional Medical Center	outpatient	216	108	WellCare of North Carolina	North Carolina Medicaid/CHIP	75.95	19.43	162
ANKLE, 2 VIEWS RT	ANKLE, 2 VIEWS RT	Radiology	73600	CPT	2001021		Washington Regional Medical Center	outpatient	216	108	Healthy Blue / Blue Cross NC	North Carolina Medicaid	75.95	19.43	162
ANKLE, 2 VIEWS RT	ANKLE, 2 VIEWS RT	Radiology	73600	CPT	2001021		Washington Regional Medical Center	outpatient	216	108	Cigna	North Carolina PPO-PPA Direct	19.43	19.43	162
ANKLE, 2 VIEWS RT	ANKLE, 2 VIEWS RT	Radiology	73600	CPT	2001021		Washington Regional Medical Center	outpatient	216	108	Original Medicare	Traditional Medicare Fee-for-Service	101.52	19.43	162
BONE &/JOINT IMAG LMTD AREA	BONE &/JOINT IMAG LMTD AREA	Radiology	78300	CPT	2001249		Washington Regional Medical Center	outpatient	626	313	Self-Pay	Discounted Cash		99.37	469.5
BONE &/JOINT IMAG LMTD AREA	BONE &/JOINT IMAG LMTD AREA	Radiology	78300	CPT	2001249		Washington Regional Medical Center	outpatient	626	313	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	469.5	99.37	469.5
BONE &/JOINT IMAG LMTD AREA	BONE &/JOINT IMAG LMTD AREA	Radiology	78300	CPT	2001249		Washington Regional Medical Center	outpatient	626	313	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	275.44	99.37	469.5
BONE &/JOINT IMAG LMTD AREA	BONE &/JOINT IMAG LMTD AREA	Radiology	78300	CPT	2001249		Washington Regional Medical Center	outpatient	626	313	Humana	Medicare Advantage HMO/PPO/PFFS	294.22	99.37	469.5
BONE &/JOINT IMAG LMTD AREA	BONE &/JOINT IMAG LMTD AREA	Radiology	78300	CPT	2001249		Washington Regional Medical Center	outpatient	626	313	AmeriHealth Caritas North Carolina	NC Medicaid	220.1	99.37	469.5
BONE &/JOINT IMAG LMTD AREA	BONE &/JOINT IMAG LMTD AREA	Radiology	78300	CPT	2001249		Washington Regional Medical Center	outpatient	626	313	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	220.1	99.37	469.5
BONE &/JOINT IMAG LMTD AREA	BONE &/JOINT IMAG LMTD AREA	Radiology	78300	CPT	2001249		Washington Regional Medical Center	outpatient	626	313	WellCare of North Carolina	North Carolina Medicaid/CHIP	220.1	99.37	469.5
BONE &/JOINT IMAG LMTD AREA	BONE &/JOINT IMAG LMTD AREA	Radiology	78300	CPT	2001249		Washington Regional Medical Center	outpatient	626	313	Healthy Blue / Blue Cross NC	North Carolina Medicaid	220.1	99.37	469.5
BONE &/JOINT IMAG LMTD AREA	BONE &/JOINT IMAG LMTD AREA	Radiology	78300	CPT	2001249		Washington Regional Medical Center	outpatient	626	313	Cigna	North Carolina PPO-PPA Direct	99.37	99.37	469.5
BONE &/JOINT IMAG LMTD AREA	BONE &/JOINT IMAG LMTD AREA	Radiology	78300	CPT	2001249		Washington Regional Medical Center	outpatient	626	313	Original Medicare	Traditional Medicare Fee-for-Service	294.22	99.37	469.5
BONE SURV, METAST, LMT	BONE SURV, METAST, LMT	Radiology	77074	CPT	2001047		Washington Regional Medical Center	outpatient	274	137	Self-Pay	Discounted Cash		42.09	205.5
BONE SURV, METAST, LMT	BONE SURV, METAST, LMT	Radiology	77074	CPT	2001047		Washington Regional Medical Center	outpatient	274	137	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	205.5	42.09	205.5
BONE SURV, METAST, LMT	BONE SURV, METAST, LMT	Radiology	77074	CPT	2001047		Washington Regional Medical Center	outpatient	274	137	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	120.56	42.09	205.5
BONE SURV, METAST, LMT	BONE SURV, METAST, LMT	Radiology	77074	CPT	2001047		Washington Regional Medical Center	outpatient	274	137	Humana	Medicare Advantage HMO/PPO/PFFS	128.78	42.09	205.5
BONE SURV, METAST, LMT	BONE SURV, METAST, LMT	Radiology	77074	CPT	2001047		Washington Regional Medical Center	outpatient	274	137	AmeriHealth Caritas North Carolina	NC Medicaid	96.34	42.09	205.5
BONE SURV, METAST, LMT	BONE SURV, METAST, LMT	Radiology	77074	CPT	2001047		Washington Regional Medical Center	outpatient	274	137	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	96.34	42.09	205.5
BONE SURV, METAST, LMT	BONE SURV, METAST, LMT	Radiology	77074	CPT	2001047		Washington Regional Medical Center	outpatient	274	137	WellCare of North Carolina	North Carolina Medicaid/CHIP	96.34	42.09	205.5
BONE SURV, METAST, LMT	BONE SURV, METAST, LMT	Radiology	77074	CPT	2001047		Washington Regional Medical Center	outpatient	274	137	Healthy Blue / Blue Cross NC	North Carolina Medicaid	96.34	42.09	205.5
BONE SURV, METAST, LMT	BONE SURV, METAST, LMT	Radiology	77074	CPT	2001047		Washington Regional Medical Center	outpatient	274	137	Cigna	North Carolina PPO-PPA Direct	42.09	42.09	205.5
BONE SURV, METAST, LMT	BONE SURV, METAST, LMT	Radiology	77074	CPT	2001047		Washington Regional Medical Center	outpatient	274	137	Original Medicare	Traditional Medicare Fee-for-Service	128.78	42.09	205.5
CHOLANGIOGRAPHY OR PANCREATOG	CHOLANGIOGRAPHY OR PANCREATOG	Radiology	74300	CPT	2001105		Washington Regional Medical Center	outpatient	448	224	Self-Pay	Discounted Cash		35.27	336
CHOLANGIOGRAPHY OR PANCREATOG	CHOLANGIOGRAPHY OR PANCREATOG	Radiology	74300	CPT	2001105		Washington Regional Medical Center	outpatient	448	224	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	336	35.27	336
CHOLANGIOGRAPHY OR PANCREATOG	CHOLANGIOGRAPHY OR PANCREATOG	Radiology	74300	CPT	2001105		Washington Regional Medical Center	outpatient	448	224	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	197.12	35.27	336
CHOLANGIOGRAPHY OR PANCREATOG	CHOLANGIOGRAPHY OR PANCREATOG	Radiology	74300	CPT	2001105		Washington Regional Medical Center	outpatient	448	224	Humana	Medicare Advantage HMO/PPO/PFFS	210.56	35.27	336
CHOLANGIOGRAPHY OR PANCREATOG	CHOLANGIOGRAPHY OR PANCREATOG	Radiology	74300	CPT	2001105		Washington Regional Medical Center	outpatient	448	224	AmeriHealth Caritas North Carolina	NC Medicaid	157.52	35.27	336
CHOLANGIOGRAPHY OR PANCREATOG	CHOLANGIOGRAPHY OR PANCREATOG	Radiology	74300	CPT	2001105		Washington Regional Medical Center	outpatient	448	224	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	157.52	35.27	336
CHOLANGIOGRAPHY OR PANCREATOG	CHOLANGIOGRAPHY OR PANCREATOG	Radiology	74300	CPT	2001105		Washington Regional Medical Center	outpatient	448	224	WellCare of North Carolina	North Carolina Medicaid/CHIP	157.52	35.27	336
CHOLANGIOGRAPHY OR PANCREATOG	CHOLANGIOGRAPHY OR PANCREATOG	Radiology	74300	CPT	2001105		Washington Regional Medical Center	outpatient	448	224	Healthy Blue / Blue Cross NC	North Carolina Medicaid	157.52	35.27	336
CHOLANGIOGRAPHY OR PANCREATOG	CHOLANGIOGRAPHY OR PANCREATOG	Radiology	74300	CPT	2001105		Washington Regional Medical Center	outpatient	448	224	Cigna	North Carolina PPO-PPA Direct	35.27	35.27	336
CHOLANGIOGRAPHY OR PANCREATOG	CHOLANGIOGRAPHY OR PANCREATOG	Radiology	74300	CPT	2001105		Washington Regional Medical Center	outpatient	448	224	Original Medicare	Traditional Medicare Fee-for-Service	210.56	35.27	336
COCCYX	COCCYX	Radiology	72220	CPT	2001107		Washington Regional Medical Center	outpatient	141	70.5	Self-Pay	Discounted Cash		23.05	105.75
COCCYX	COCCYX	Radiology	72220	CPT	2001107		Washington Regional Medical Center	outpatient	141	70.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	105.75	23.05	105.75
COCCYX	COCCYX	Radiology	72220	CPT	2001107		Washington Regional Medical Center	outpatient	141	70.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	62.04	23.05	105.75
COCCYX	COCCYX	Radiology	72220	CPT	2001107		Washington Regional Medical Center	outpatient	141	70.5	Humana	Medicare Advantage HMO/PPO/PFFS	66.27	23.05	105.75
COCCYX	COCCYX	Radiology	72220	CPT	2001107		Washington Regional Medical Center	outpatient	141	70.5	AmeriHealth Caritas North Carolina	NC Medicaid	49.58	23.05	105.75
COCCYX	COCCYX	Radiology	72220	CPT	2001107		Washington Regional Medical Center	outpatient	141	70.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	49.58	23.05	105.75
COCCYX	COCCYX	Radiology	72220	CPT	2001107		Washington Regional Medical Center	outpatient	141	70.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	49.58	23.05	105.75
COCCYX	COCCYX	Radiology	72220	CPT	2001107		Washington Regional Medical Center	outpatient	141	70.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	49.58	23.05	105.75
COCCYX	COCCYX	Radiology	72220	CPT	2001107		Washington Regional Medical Center	outpatient	141	70.5	Cigna	North Carolina PPO-PPA Direct	23.05	23.05	105.75
COCCYX	COCCYX	Radiology	72220	CPT	2001107		Washington Regional Medical Center	outpatient	141	70.5	Original Medicare	Traditional Medicare Fee-for-Service	66.27	23.05	105.75
CT ABD ONLY W/C	CT ABD ONLY W/C	Radiology	74160	CPT	2201001		Washington Regional Medical Center	outpatient	2527	1263.5	Self-Pay	Discounted Cash		273.36	1895.25
CT ABD ONLY W/C	CT ABD ONLY W/C	Radiology	74160	CPT	2201001		Washington Regional Medical Center	outpatient	2527	1263.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1895.25	273.36	1895.25
CT ABD ONLY W/C	CT ABD ONLY W/C	Radiology	74160	CPT	2201001		Washington Regional Medical Center	outpatient	2527	1263.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	1111.88	273.36	1895.25
CT ABD ONLY W/C	CT ABD ONLY W/C	Radiology	74160	CPT	2201001		Washington Regional Medical Center	outpatient	2527	1263.5	Humana	Medicare Advantage HMO/PPO/PFFS	1187.69	273.36	1895.25
CT ABD ONLY W/C	CT ABD ONLY W/C	Radiology	74160	CPT	2201001		Washington Regional Medical Center	outpatient	2527	1263.5	AmeriHealth Caritas North Carolina	NC Medicaid	888.49	273.36	1895.25
CT ABD ONLY W/C	CT ABD ONLY W/C	Radiology	74160	CPT	2201001		Washington Regional Medical Center	outpatient	2527	1263.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	888.49	273.36	1895.25
CT ABD ONLY W/C	CT ABD ONLY W/C	Radiology	74160	CPT	2201001		Washington Regional Medical Center	outpatient	2527	1263.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	888.49	273.36	1895.25
CT ABD ONLY W/C	CT ABD ONLY W/C	Radiology	74160	CPT	2201001		Washington Regional Medical Center	outpatient	2527	1263.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	888.49	273.36	1895.25
CT ABD ONLY W/C	CT ABD ONLY W/C	Radiology	74160	CPT	2201001		Washington Regional Medical Center	outpatient	2527	1263.5	Cigna	North Carolina PPO-PPA Direct	273.36	273.36	1895.25
CT ABD ONLY W/C	CT ABD ONLY W/C	Radiology	74160	CPT	2201001		Washington Regional Medical Center	outpatient	2527	1263.5	Original Medicare	Traditional Medicare Fee-for-Service	1187.69	273.36	1895.25
CT ANG AORTA	CT ANG AORTA	Radiology	75635	CPT	2201095		Washington Regional Medical Center	outpatient	2246	1123	Self-Pay	Discounted Cash		623.91	1684.5
CT ANG AORTA	CT ANG AORTA	Radiology	75635	CPT	2201095		Washington Regional Medical Center	outpatient	2246	1123	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1684.5	623.91	1684.5
CT ANG AORTA	CT ANG AORTA	Radiology	75635	CPT	2201095		Washington Regional Medical Center	outpatient	2246	1123	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	988.24	623.91	1684.5
CT ANG AORTA	CT ANG AORTA	Radiology	75635	CPT	2201095		Washington Regional Medical Center	outpatient	2246	1123	Humana	Medicare Advantage HMO/PPO/PFFS	1055.62	623.91	1684.5
CT ANG AORTA	CT ANG AORTA	Radiology	75635	CPT	2201095		Washington Regional Medical Center	outpatient	2246	1123	AmeriHealth Caritas North Carolina	NC Medicaid	789.69	623.91	1684.5
CT ANG AORTA	CT ANG AORTA	Radiology	75635	CPT	2201095		Washington Regional Medical Center	outpatient	2246	1123	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	789.69	623.91	1684.5
CT ANG AORTA	CT ANG AORTA	Radiology	75635	CPT	2201095		Washington Regional Medical Center	outpatient	2246	1123	WellCare of North Carolina	North Carolina Medicaid/CHIP	789.69	623.91	1684.5
CT ANG AORTA	CT ANG AORTA	Radiology	75635	CPT	2201095		Washington Regional Medical Center	outpatient	2246	1123	Healthy Blue / Blue Cross NC	North Carolina Medicaid	789.69	623.91	1684.5
CT ANG AORTA	CT ANG AORTA	Radiology	75635	CPT	2201095		Washington Regional Medical Center	outpatient	2246	1123	Cigna	North Carolina PPO-PPA Direct	623.91	623.91	1684.5
CT ANG AORTA	CT ANG AORTA	Radiology	75635	CPT	2201095		Washington Regional Medical Center	outpatient	2246	1123	Original Medicare	Traditional Medicare Fee-for-Service	1055.62	623.91	1684.5
CT ANGIO HEAD	CT ANGIO HEAD	Radiology	70496	CPT	2201041		Washington Regional Medical Center	outpatient	2919	1459.5	Self-Pay	Discounted Cash		424.22	2189.25
CT ANGIO HEAD	CT ANGIO HEAD	Radiology	70496	CPT	2201041		Washington Regional Medical Center	outpatient	2919	1459.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	2189.25	424.22	2189.25
CT ANGIO HEAD	CT ANGIO HEAD	Radiology	70496	CPT	2201041		Washington Regional Medical Center	outpatient	2919	1459.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	1284.36	424.22	2189.25
CT ANGIO HEAD	CT ANGIO HEAD	Radiology	70496	CPT	2201041		Washington Regional Medical Center	outpatient	2919	1459.5	Humana	Medicare Advantage HMO/PPO/PFFS	1371.93	424.22	2189.25
CT ANGIO HEAD	CT ANGIO HEAD	Radiology	70496	CPT	2201041		Washington Regional Medical Center	outpatient	2919	1459.5	AmeriHealth Caritas North Carolina	NC Medicaid	1026.32	424.22	2189.25
CT ANGIO HEAD	CT ANGIO HEAD	Radiology	70496	CPT	2201041		Washington Regional Medical Center	outpatient	2919	1459.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	1026.32	424.22	2189.25
CT ANGIO HEAD	CT ANGIO HEAD	Radiology	70496	CPT	2201041		Washington Regional Medical Center	outpatient	2919	1459.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	1026.32	424.22	2189.25
CT ANGIO HEAD	CT ANGIO HEAD	Radiology	70496	CPT	2201041		Washington Regional Medical Center	outpatient	2919	1459.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	1026.32	424.22	2189.25
CT ANGIO HEAD	CT ANGIO HEAD	Radiology	70496	CPT	2201041		Washington Regional Medical Center	outpatient	2919	1459.5	Cigna	North Carolina PPO-PPA Direct	424.22	424.22	2189.25
CT ANGIO HEAD	CT ANGIO HEAD	Radiology	70496	CPT	2201041		Washington Regional Medical Center	outpatient	2919	1459.5	Original Medicare	Traditional Medicare Fee-for-Service	1371.93	424.22	2189.25
CT ANGIO RENAL ARTERY	CT ANGIO RENAL ARTERY	Radiology	74175	CPT	2201047		Washington Regional Medical Center	outpatient	2919	1459.5	Self-Pay	Discounted Cash		474.29	2189.25
CT ANGIO RENAL ARTERY	CT ANGIO RENAL ARTERY	Radiology	74175	CPT	2201047		Washington Regional Medical Center	outpatient	2919	1459.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	2189.25	474.29	2189.25
CT ANGIO RENAL ARTERY	CT ANGIO RENAL ARTERY	Radiology	74175	CPT	2201047		Washington Regional Medical Center	outpatient	2919	1459.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	1284.36	474.29	2189.25
CT ANGIO RENAL ARTERY	CT ANGIO RENAL ARTERY	Radiology	74175	CPT	2201047		Washington Regional Medical Center	outpatient	2919	1459.5	Humana	Medicare Advantage HMO/PPO/PFFS	1371.93	474.29	2189.25
CT ANGIO RENAL ARTERY	CT ANGIO RENAL ARTERY	Radiology	74175	CPT	2201047		Washington Regional Medical Center	outpatient	2919	1459.5	AmeriHealth Caritas North Carolina	NC Medicaid	1026.32	474.29	2189.25
CT ANGIO RENAL ARTERY	CT ANGIO RENAL ARTERY	Radiology	74175	CPT	2201047		Washington Regional Medical Center	outpatient	2919	1459.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	1026.32	474.29	2189.25
CT ANGIO RENAL ARTERY	CT ANGIO RENAL ARTERY	Radiology	74175	CPT	2201047		Washington Regional Medical Center	outpatient	2919	1459.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	1026.32	474.29	2189.25
CT ANGIO RENAL ARTERY	CT ANGIO RENAL ARTERY	Radiology	74175	CPT	2201047		Washington Regional Medical Center	outpatient	2919	1459.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	1026.32	474.29	2189.25
CT ANGIO RENAL ARTERY	CT ANGIO RENAL ARTERY	Radiology	74175	CPT	2201047		Washington Regional Medical Center	outpatient	2919	1459.5	Cigna	North Carolina PPO-PPA Direct	474.29	474.29	2189.25
CT ANGIO RENAL ARTERY	CT ANGIO RENAL ARTERY	Radiology	74175	CPT	2201047		Washington Regional Medical Center	outpatient	2919	1459.5	Original Medicare	Traditional Medicare Fee-for-Service	1371.93	474.29	2189.25
CT ANGIO UE LT	CT ANGIO UE LT	Radiology	73206	CPT	2201096		Washington Regional Medical Center	outpatient	2491	1245.5	Self-Pay	Discounted Cash		433.03	1868.25
CT ANGIO UE LT	CT ANGIO UE LT	Radiology	73206	CPT	2201096		Washington Regional Medical Center	outpatient	2491	1245.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1868.25	433.03	1868.25
CT ANGIO UE LT	CT ANGIO UE LT	Radiology	73206	CPT	2201096		Washington Regional Medical Center	outpatient	2491	1245.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	1096.04	433.03	1868.25
CT ANGIO UE LT	CT ANGIO UE LT	Radiology	73206	CPT	2201096		Washington Regional Medical Center	outpatient	2491	1245.5	Humana	Medicare Advantage HMO/PPO/PFFS	1170.77	433.03	1868.25
CT ANGIO UE LT	CT ANGIO UE LT	Radiology	73206	CPT	2201096		Washington Regional Medical Center	outpatient	2491	1245.5	AmeriHealth Caritas North Carolina	NC Medicaid	875.84	433.03	1868.25
CT ANGIO UE LT	CT ANGIO UE LT	Radiology	73206	CPT	2201096		Washington Regional Medical Center	outpatient	2491	1245.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	875.84	433.03	1868.25
CT ANGIO UE LT	CT ANGIO UE LT	Radiology	73206	CPT	2201096		Washington Regional Medical Center	outpatient	2491	1245.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	875.84	433.03	1868.25
CT ANGIO UE LT	CT ANGIO UE LT	Radiology	73206	CPT	2201096		Washington Regional Medical Center	outpatient	2491	1245.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	875.84	433.03	1868.25
CT ANGIO UE LT	CT ANGIO UE LT	Radiology	73206	CPT	2201096		Washington Regional Medical Center	outpatient	2491	1245.5	Cigna	North Carolina PPO-PPA Direct	433.03	433.03	1868.25
CT ANGIO UE LT	CT ANGIO UE LT	Radiology	73206	CPT	2201096		Washington Regional Medical Center	outpatient	2491	1245.5	Original Medicare	Traditional Medicare Fee-for-Service	1170.77	433.03	1868.25
CT ANGIO UE RT	CT ANGIO UE RT	Radiology	73206	CPT	2201097		Washington Regional Medical Center	outpatient	2491	1245.5	Self-Pay	Discounted Cash		433.03	1868.25
CT ANGIO UE RT	CT ANGIO UE RT	Radiology	73206	CPT	2201097		Washington Regional Medical Center	outpatient	2491	1245.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1868.25	433.03	1868.25
CT ANGIO UE RT	CT ANGIO UE RT	Radiology	73206	CPT	2201097		Washington Regional Medical Center	outpatient	2491	1245.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	1096.04	433.03	1868.25
CT ANGIO UE RT	CT ANGIO UE RT	Radiology	73206	CPT	2201097		Washington Regional Medical Center	outpatient	2491	1245.5	Humana	Medicare Advantage HMO/PPO/PFFS	1170.77	433.03	1868.25
CT ANGIO UE RT	CT ANGIO UE RT	Radiology	73206	CPT	2201097		Washington Regional Medical Center	outpatient	2491	1245.5	AmeriHealth Caritas North Carolina	NC Medicaid	875.84	433.03	1868.25
CT ANGIO UE RT	CT ANGIO UE RT	Radiology	73206	CPT	2201097		Washington Regional Medical Center	outpatient	2491	1245.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	875.84	433.03	1868.25
CT ANGIO UE RT	CT ANGIO UE RT	Radiology	73206	CPT	2201097		Washington Regional Medical Center	outpatient	2491	1245.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	875.84	433.03	1868.25
CT ANGIO UE RT	CT ANGIO UE RT	Radiology	73206	CPT	2201097		Washington Regional Medical Center	outpatient	2491	1245.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	875.84	433.03	1868.25
CT ANGIO UE RT	CT ANGIO UE RT	Radiology	73206	CPT	2201097		Washington Regional Medical Center	outpatient	2491	1245.5	Cigna	North Carolina PPO-PPA Direct	433.03	433.03	1868.25
CT ANGIO UE RT	CT ANGIO UE RT	Radiology	73206	CPT	2201097		Washington Regional Medical Center	outpatient	2491	1245.5	Original Medicare	Traditional Medicare Fee-for-Service	1170.77	433.03	1868.25
CT ANKLE LT W CON	CT ANKLE LT W CON	Radiology	73701	CPT	2201098		Washington Regional Medical Center	outpatient	1767	883.5	Self-Pay	Discounted Cash		236.16	1325.25
CT ANKLE LT W CON	CT ANKLE LT W CON	Radiology	73701	CPT	2201098		Washington Regional Medical Center	outpatient	1767	883.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1325.25	236.16	1325.25
CT ANKLE LT W CON	CT ANKLE LT W CON	Radiology	73701	CPT	2201098		Washington Regional Medical Center	outpatient	1767	883.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	777.48	236.16	1325.25
CT ANKLE LT W CON	CT ANKLE LT W CON	Radiology	73701	CPT	2201098		Washington Regional Medical Center	outpatient	1767	883.5	Humana	Medicare Advantage HMO/PPO/PFFS	830.49	236.16	1325.25
CT ANKLE LT W CON	CT ANKLE LT W CON	Radiology	73701	CPT	2201098		Washington Regional Medical Center	outpatient	1767	883.5	AmeriHealth Caritas North Carolina	NC Medicaid	621.28	236.16	1325.25
CT ANKLE LT W CON	CT ANKLE LT W CON	Radiology	73701	CPT	2201098		Washington Regional Medical Center	outpatient	1767	883.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	621.28	236.16	1325.25
CT ANKLE LT W CON	CT ANKLE LT W CON	Radiology	73701	CPT	2201098		Washington Regional Medical Center	outpatient	1767	883.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	621.28	236.16	1325.25
CT ANKLE LT W CON	CT ANKLE LT W CON	Radiology	73701	CPT	2201098		Washington Regional Medical Center	outpatient	1767	883.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	621.28	236.16	1325.25
CT ANKLE LT W CON	CT ANKLE LT W CON	Radiology	73701	CPT	2201098		Washington Regional Medical Center	outpatient	1767	883.5	Cigna	North Carolina PPO-PPA Direct	236.16	236.16	1325.25
CT ANKLE LT W CON	CT ANKLE LT W CON	Radiology	73701	CPT	2201098		Washington Regional Medical Center	outpatient	1767	883.5	Original Medicare	Traditional Medicare Fee-for-Service	830.49	236.16	1325.25
CT ANKLE RT W CON	CT ANKLE RT W CON	Radiology	73701	CPT	2201101		Washington Regional Medical Center	outpatient	1767	883.5	Self-Pay	Discounted Cash		236.16	1325.25
CT ANKLE RT W CON	CT ANKLE RT W CON	Radiology	73701	CPT	2201101		Washington Regional Medical Center	outpatient	1767	883.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1325.25	236.16	1325.25
CT ANKLE RT W CON	CT ANKLE RT W CON	Radiology	73701	CPT	2201101		Washington Regional Medical Center	outpatient	1767	883.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	777.48	236.16	1325.25
CT ANKLE RT W CON	CT ANKLE RT W CON	Radiology	73701	CPT	2201101		Washington Regional Medical Center	outpatient	1767	883.5	Humana	Medicare Advantage HMO/PPO/PFFS	830.49	236.16	1325.25
CT ANKLE RT W CON	CT ANKLE RT W CON	Radiology	73701	CPT	2201101		Washington Regional Medical Center	outpatient	1767	883.5	AmeriHealth Caritas North Carolina	NC Medicaid	621.28	236.16	1325.25
CT ANKLE RT W CON	CT ANKLE RT W CON	Radiology	73701	CPT	2201101		Washington Regional Medical Center	outpatient	1767	883.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	621.28	236.16	1325.25
CT ANKLE RT W CON	CT ANKLE RT W CON	Radiology	73701	CPT	2201101		Washington Regional Medical Center	outpatient	1767	883.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	621.28	236.16	1325.25
CT ANKLE RT W CON	CT ANKLE RT W CON	Radiology	73701	CPT	2201101		Washington Regional Medical Center	outpatient	1767	883.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	621.28	236.16	1325.25
CT ANKLE RT W CON	CT ANKLE RT W CON	Radiology	73701	CPT	2201101		Washington Regional Medical Center	outpatient	1767	883.5	Cigna	North Carolina PPO-PPA Direct	236.16	236.16	1325.25
CT ANKLE RT W CON	CT ANKLE RT W CON	Radiology	73701	CPT	2201101		Washington Regional Medical Center	outpatient	1767	883.5	Original Medicare	Traditional Medicare Fee-for-Service	830.49	236.16	1325.25
CT ELBOW LT WO CON	CT ELBOW LT WO CON	Radiology	73200	CPT	10066347		Washington Regional Medical Center	outpatient	1381	690.5	Self-Pay	Discounted Cash		197.93	1035.75
CT ELBOW LT WO CON	CT ELBOW LT WO CON	Radiology	73200	CPT	10066347		Washington Regional Medical Center	outpatient	1381	690.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1035.75	197.93	1035.75
CT ELBOW LT WO CON	CT ELBOW LT WO CON	Radiology	73200	CPT	10066347		Washington Regional Medical Center	outpatient	1381	690.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	607.64	197.93	1035.75
CT ELBOW LT WO CON	CT ELBOW LT WO CON	Radiology	73200	CPT	10066347		Washington Regional Medical Center	outpatient	1381	690.5	Humana	Medicare Advantage HMO/PPO/PFFS	649.07	197.93	1035.75
CT ELBOW LT WO CON	CT ELBOW LT WO CON	Radiology	73200	CPT	10066347		Washington Regional Medical Center	outpatient	1381	690.5	AmeriHealth Caritas North Carolina	NC Medicaid	485.56	197.93	1035.75
CT ELBOW LT WO CON	CT ELBOW LT WO CON	Radiology	73200	CPT	10066347		Washington Regional Medical Center	outpatient	1381	690.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	485.56	197.93	1035.75
CT ELBOW LT WO CON	CT ELBOW LT WO CON	Radiology	73200	CPT	10066347		Washington Regional Medical Center	outpatient	1381	690.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	485.56	197.93	1035.75
CT ELBOW LT WO CON	CT ELBOW LT WO CON	Radiology	73200	CPT	10066347		Washington Regional Medical Center	outpatient	1381	690.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	485.56	197.93	1035.75
CT ELBOW LT WO CON	CT ELBOW LT WO CON	Radiology	73200	CPT	10066347		Washington Regional Medical Center	outpatient	1381	690.5	Cigna	North Carolina PPO-PPA Direct	197.93	197.93	1035.75
CT ELBOW LT WO CON	CT ELBOW LT WO CON	Radiology	73200	CPT	10066347		Washington Regional Medical Center	outpatient	1381	690.5	Original Medicare	Traditional Medicare Fee-for-Service	649.07	197.93	1035.75
CT ELBOW RT WO CON	CT ELBOW RT WO CON	Radiology	73200	CPT	2201049		Washington Regional Medical Center	outpatient	1381	690.5	Self-Pay	Discounted Cash		197.93	1035.75
CT ELBOW RT WO CON	CT ELBOW RT WO CON	Radiology	73200	CPT	2201049		Washington Regional Medical Center	outpatient	1381	690.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1035.75	197.93	1035.75
CT ELBOW RT WO CON	CT ELBOW RT WO CON	Radiology	73200	CPT	2201049		Washington Regional Medical Center	outpatient	1381	690.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	607.64	197.93	1035.75
CT ELBOW RT WO CON	CT ELBOW RT WO CON	Radiology	73200	CPT	2201049		Washington Regional Medical Center	outpatient	1381	690.5	Humana	Medicare Advantage HMO/PPO/PFFS	649.07	197.93	1035.75
CT ELBOW RT WO CON	CT ELBOW RT WO CON	Radiology	73200	CPT	2201049		Washington Regional Medical Center	outpatient	1381	690.5	AmeriHealth Caritas North Carolina	NC Medicaid	485.56	197.93	1035.75
CT ELBOW RT WO CON	CT ELBOW RT WO CON	Radiology	73200	CPT	2201049		Washington Regional Medical Center	outpatient	1381	690.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	485.56	197.93	1035.75
CT ELBOW RT WO CON	CT ELBOW RT WO CON	Radiology	73200	CPT	2201049		Washington Regional Medical Center	outpatient	1381	690.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	485.56	197.93	1035.75
CT ELBOW RT WO CON	CT ELBOW RT WO CON	Radiology	73200	CPT	2201049		Washington Regional Medical Center	outpatient	1381	690.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	485.56	197.93	1035.75
CT ELBOW RT WO CON	CT ELBOW RT WO CON	Radiology	73200	CPT	2201049		Washington Regional Medical Center	outpatient	1381	690.5	Cigna	North Carolina PPO-PPA Direct	197.93	197.93	1035.75
CT ELBOW RT WO CON	CT ELBOW RT WO CON	Radiology	73200	CPT	2201049		Washington Regional Medical Center	outpatient	1381	690.5	Original Medicare	Traditional Medicare Fee-for-Service	649.07	197.93	1035.75
CT FACIAL W/WO C	CT FACIAL W/WO C	Radiology	70488	CPT	2201014		Washington Regional Medical Center	outpatient	1737	868.5	Self-Pay	Discounted Cash		282.5	1302.75
CT FACIAL W/WO C	CT FACIAL W/WO C	Radiology	70488	CPT	2201014		Washington Regional Medical Center	outpatient	1737	868.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1302.75	282.5	1302.75
CT FACIAL W/WO C	CT FACIAL W/WO C	Radiology	70488	CPT	2201014		Washington Regional Medical Center	outpatient	1737	868.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	764.28	282.5	1302.75
CT FACIAL W/WO C	CT FACIAL W/WO C	Radiology	70488	CPT	2201014		Washington Regional Medical Center	outpatient	1737	868.5	Humana	Medicare Advantage HMO/PPO/PFFS	816.39	282.5	1302.75
CT FACIAL W/WO C	CT FACIAL W/WO C	Radiology	70488	CPT	2201014		Washington Regional Medical Center	outpatient	1737	868.5	AmeriHealth Caritas North Carolina	NC Medicaid	610.73	282.5	1302.75
CT FACIAL W/WO C	CT FACIAL W/WO C	Radiology	70488	CPT	2201014		Washington Regional Medical Center	outpatient	1737	868.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	610.73	282.5	1302.75
CT FACIAL W/WO C	CT FACIAL W/WO C	Radiology	70488	CPT	2201014		Washington Regional Medical Center	outpatient	1737	868.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	610.73	282.5	1302.75
CT FACIAL W/WO C	CT FACIAL W/WO C	Radiology	70488	CPT	2201014		Washington Regional Medical Center	outpatient	1737	868.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	610.73	282.5	1302.75
CT FACIAL W/WO C	CT FACIAL W/WO C	Radiology	70488	CPT	2201014		Washington Regional Medical Center	outpatient	1737	868.5	Cigna	North Carolina PPO-PPA Direct	282.5	282.5	1302.75
CT FACIAL W/WO C	CT FACIAL W/WO C	Radiology	70488	CPT	2201014		Washington Regional Medical Center	outpatient	1737	868.5	Original Medicare	Traditional Medicare Fee-for-Service	816.39	282.5	1302.75
CT FEMUR LT W CON	CT FEMUR LT W CON	Radiology	73701	CPT	2201113		Washington Regional Medical Center	outpatient	1767	883.5	Self-Pay	Discounted Cash		236.16	1325.25
CT FEMUR LT W CON	CT FEMUR LT W CON	Radiology	73701	CPT	2201113		Washington Regional Medical Center	outpatient	1767	883.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1325.25	236.16	1325.25
CT FEMUR LT W CON	CT FEMUR LT W CON	Radiology	73701	CPT	2201113		Washington Regional Medical Center	outpatient	1767	883.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	777.48	236.16	1325.25
CT FEMUR LT W CON	CT FEMUR LT W CON	Radiology	73701	CPT	2201113		Washington Regional Medical Center	outpatient	1767	883.5	Humana	Medicare Advantage HMO/PPO/PFFS	830.49	236.16	1325.25
CT FEMUR LT W CON	CT FEMUR LT W CON	Radiology	73701	CPT	2201113		Washington Regional Medical Center	outpatient	1767	883.5	AmeriHealth Caritas North Carolina	NC Medicaid	621.28	236.16	1325.25
CT FEMUR LT W CON	CT FEMUR LT W CON	Radiology	73701	CPT	2201113		Washington Regional Medical Center	outpatient	1767	883.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	621.28	236.16	1325.25
CT FEMUR LT W CON	CT FEMUR LT W CON	Radiology	73701	CPT	2201113		Washington Regional Medical Center	outpatient	1767	883.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	621.28	236.16	1325.25
CT FEMUR LT W CON	CT FEMUR LT W CON	Radiology	73701	CPT	2201113		Washington Regional Medical Center	outpatient	1767	883.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	621.28	236.16	1325.25
CT FEMUR LT W CON	CT FEMUR LT W CON	Radiology	73701	CPT	2201113		Washington Regional Medical Center	outpatient	1767	883.5	Cigna	North Carolina PPO-PPA Direct	236.16	236.16	1325.25
CT FEMUR LT W CON	CT FEMUR LT W CON	Radiology	73701	CPT	2201113		Washington Regional Medical Center	outpatient	1767	883.5	Original Medicare	Traditional Medicare Fee-for-Service	830.49	236.16	1325.25
CT FEMUR RT W CON	CT FEMUR RT W CON	Radiology	73701	CPT	2201116		Washington Regional Medical Center	outpatient	1767	883.5	Self-Pay	Discounted Cash		236.16	1325.25
CT FEMUR RT W CON	CT FEMUR RT W CON	Radiology	73701	CPT	2201116		Washington Regional Medical Center	outpatient	1767	883.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1325.25	236.16	1325.25
CT FEMUR RT W CON	CT FEMUR RT W CON	Radiology	73701	CPT	2201116		Washington Regional Medical Center	outpatient	1767	883.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	777.48	236.16	1325.25
CT FEMUR RT W CON	CT FEMUR RT W CON	Radiology	73701	CPT	2201116		Washington Regional Medical Center	outpatient	1767	883.5	Humana	Medicare Advantage HMO/PPO/PFFS	830.49	236.16	1325.25
CT FEMUR RT W CON	CT FEMUR RT W CON	Radiology	73701	CPT	2201116		Washington Regional Medical Center	outpatient	1767	883.5	AmeriHealth Caritas North Carolina	NC Medicaid	621.28	236.16	1325.25
CT FEMUR RT W CON	CT FEMUR RT W CON	Radiology	73701	CPT	2201116		Washington Regional Medical Center	outpatient	1767	883.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	621.28	236.16	1325.25
CT FEMUR RT W CON	CT FEMUR RT W CON	Radiology	73701	CPT	2201116		Washington Regional Medical Center	outpatient	1767	883.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	621.28	236.16	1325.25
CT FEMUR RT W CON	CT FEMUR RT W CON	Radiology	73701	CPT	2201116		Washington Regional Medical Center	outpatient	1767	883.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	621.28	236.16	1325.25
CT FEMUR RT W CON	CT FEMUR RT W CON	Radiology	73701	CPT	2201116		Washington Regional Medical Center	outpatient	1767	883.5	Cigna	North Carolina PPO-PPA Direct	236.16	236.16	1325.25
CT FEMUR RT W CON	CT FEMUR RT W CON	Radiology	73701	CPT	2201116		Washington Regional Medical Center	outpatient	1767	883.5	Original Medicare	Traditional Medicare Fee-for-Service	830.49	236.16	1325.25
CT FOOT LT W CON	CT FOOT LT W CON	Radiology	73701	CPT	2201119		Washington Regional Medical Center	outpatient	1767	883.5	Self-Pay	Discounted Cash		236.16	1325.25
CT FOOT LT W CON	CT FOOT LT W CON	Radiology	73701	CPT	2201119		Washington Regional Medical Center	outpatient	1767	883.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1325.25	236.16	1325.25
CT FOOT LT W CON	CT FOOT LT W CON	Radiology	73701	CPT	2201119		Washington Regional Medical Center	outpatient	1767	883.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	777.48	236.16	1325.25
CT FOOT LT W CON	CT FOOT LT W CON	Radiology	73701	CPT	2201119		Washington Regional Medical Center	outpatient	1767	883.5	Humana	Medicare Advantage HMO/PPO/PFFS	830.49	236.16	1325.25
CT FOOT LT W CON	CT FOOT LT W CON	Radiology	73701	CPT	2201119		Washington Regional Medical Center	outpatient	1767	883.5	AmeriHealth Caritas North Carolina	NC Medicaid	621.28	236.16	1325.25
CT FOOT LT W CON	CT FOOT LT W CON	Radiology	73701	CPT	2201119		Washington Regional Medical Center	outpatient	1767	883.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	621.28	236.16	1325.25
CT FOOT LT W CON	CT FOOT LT W CON	Radiology	73701	CPT	2201119		Washington Regional Medical Center	outpatient	1767	883.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	621.28	236.16	1325.25
CT FOOT LT W CON	CT FOOT LT W CON	Radiology	73701	CPT	2201119		Washington Regional Medical Center	outpatient	1767	883.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	621.28	236.16	1325.25
CT FOOT LT W CON	CT FOOT LT W CON	Radiology	73701	CPT	2201119		Washington Regional Medical Center	outpatient	1767	883.5	Cigna	North Carolina PPO-PPA Direct	236.16	236.16	1325.25
CT FOOT LT W CON	CT FOOT LT W CON	Radiology	73701	CPT	2201119		Washington Regional Medical Center	outpatient	1767	883.5	Original Medicare	Traditional Medicare Fee-for-Service	830.49	236.16	1325.25
CT FOOT RT W CON	CT FOOT RT W CON	Radiology	73701	CPT	2201122		Washington Regional Medical Center	outpatient	1767	883.5	Self-Pay	Discounted Cash		236.16	1325.25
CT FOOT RT W CON	CT FOOT RT W CON	Radiology	73701	CPT	2201122		Washington Regional Medical Center	outpatient	1767	883.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1325.25	236.16	1325.25
CT FOOT RT W CON	CT FOOT RT W CON	Radiology	73701	CPT	2201122		Washington Regional Medical Center	outpatient	1767	883.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	777.48	236.16	1325.25
CT FOOT RT W CON	CT FOOT RT W CON	Radiology	73701	CPT	2201122		Washington Regional Medical Center	outpatient	1767	883.5	Humana	Medicare Advantage HMO/PPO/PFFS	830.49	236.16	1325.25
CT FOOT RT W CON	CT FOOT RT W CON	Radiology	73701	CPT	2201122		Washington Regional Medical Center	outpatient	1767	883.5	AmeriHealth Caritas North Carolina	NC Medicaid	621.28	236.16	1325.25
CT FOOT RT W CON	CT FOOT RT W CON	Radiology	73701	CPT	2201122		Washington Regional Medical Center	outpatient	1767	883.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	621.28	236.16	1325.25
CT FOOT RT W CON	CT FOOT RT W CON	Radiology	73701	CPT	2201122		Washington Regional Medical Center	outpatient	1767	883.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	621.28	236.16	1325.25
CT FOOT RT W CON	CT FOOT RT W CON	Radiology	73701	CPT	2201122		Washington Regional Medical Center	outpatient	1767	883.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	621.28	236.16	1325.25
CT FOOT RT W CON	CT FOOT RT W CON	Radiology	73701	CPT	2201122		Washington Regional Medical Center	outpatient	1767	883.5	Cigna	North Carolina PPO-PPA Direct	236.16	236.16	1325.25
CT FOOT RT W CON	CT FOOT RT W CON	Radiology	73701	CPT	2201122		Washington Regional Medical Center	outpatient	1767	883.5	Original Medicare	Traditional Medicare Fee-for-Service	830.49	236.16	1325.25
CT FOREARM LT WO CON	CT FOREARM LT WO CON	Radiology	73200	CPT	2201108		Washington Regional Medical Center	outpatient	1381	690.5	Self-Pay	Discounted Cash		197.93	1035.75
CT FOREARM LT WO CON	CT FOREARM LT WO CON	Radiology	73200	CPT	2201108		Washington Regional Medical Center	outpatient	1381	690.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1035.75	197.93	1035.75
CT FOREARM LT WO CON	CT FOREARM LT WO CON	Radiology	73200	CPT	2201108		Washington Regional Medical Center	outpatient	1381	690.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	607.64	197.93	1035.75
CT FOREARM LT WO CON	CT FOREARM LT WO CON	Radiology	73200	CPT	2201108		Washington Regional Medical Center	outpatient	1381	690.5	Humana	Medicare Advantage HMO/PPO/PFFS	649.07	197.93	1035.75
CT FOREARM LT WO CON	CT FOREARM LT WO CON	Radiology	73200	CPT	2201108		Washington Regional Medical Center	outpatient	1381	690.5	AmeriHealth Caritas North Carolina	NC Medicaid	485.56	197.93	1035.75
CT FOREARM LT WO CON	CT FOREARM LT WO CON	Radiology	73200	CPT	2201108		Washington Regional Medical Center	outpatient	1381	690.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	485.56	197.93	1035.75
CT FOREARM LT WO CON	CT FOREARM LT WO CON	Radiology	73200	CPT	2201108		Washington Regional Medical Center	outpatient	1381	690.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	485.56	197.93	1035.75
CT FOREARM LT WO CON	CT FOREARM LT WO CON	Radiology	73200	CPT	2201108		Washington Regional Medical Center	outpatient	1381	690.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	485.56	197.93	1035.75
CT FOREARM LT WO CON	CT FOREARM LT WO CON	Radiology	73200	CPT	2201108		Washington Regional Medical Center	outpatient	1381	690.5	Cigna	North Carolina PPO-PPA Direct	197.93	197.93	1035.75
CT FOREARM LT WO CON	CT FOREARM LT WO CON	Radiology	73200	CPT	2201108		Washington Regional Medical Center	outpatient	1381	690.5	Original Medicare	Traditional Medicare Fee-for-Service	649.07	197.93	1035.75
CT FOREARM RT WO CON	CT FOREARM RT WO CON	Radiology	73200	CPT	2201111		Washington Regional Medical Center	outpatient	1381	690.5	Self-Pay	Discounted Cash		197.93	1035.75
CT FOREARM RT WO CON	CT FOREARM RT WO CON	Radiology	73200	CPT	2201111		Washington Regional Medical Center	outpatient	1381	690.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1035.75	197.93	1035.75
CT FOREARM RT WO CON	CT FOREARM RT WO CON	Radiology	73200	CPT	2201111		Washington Regional Medical Center	outpatient	1381	690.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	607.64	197.93	1035.75
CT FOREARM RT WO CON	CT FOREARM RT WO CON	Radiology	73200	CPT	2201111		Washington Regional Medical Center	outpatient	1381	690.5	Humana	Medicare Advantage HMO/PPO/PFFS	649.07	197.93	1035.75
CT FOREARM RT WO CON	CT FOREARM RT WO CON	Radiology	73200	CPT	2201111		Washington Regional Medical Center	outpatient	1381	690.5	AmeriHealth Caritas North Carolina	NC Medicaid	485.56	197.93	1035.75
CT FOREARM RT WO CON	CT FOREARM RT WO CON	Radiology	73200	CPT	2201111		Washington Regional Medical Center	outpatient	1381	690.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	485.56	197.93	1035.75
CT FOREARM RT WO CON	CT FOREARM RT WO CON	Radiology	73200	CPT	2201111		Washington Regional Medical Center	outpatient	1381	690.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	485.56	197.93	1035.75
CT FOREARM RT WO CON	CT FOREARM RT WO CON	Radiology	73200	CPT	2201111		Washington Regional Medical Center	outpatient	1381	690.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	485.56	197.93	1035.75
CT FOREARM RT WO CON	CT FOREARM RT WO CON	Radiology	73200	CPT	2201111		Washington Regional Medical Center	outpatient	1381	690.5	Cigna	North Carolina PPO-PPA Direct	197.93	197.93	1035.75
CT FOREARM RT WO CON	CT FOREARM RT WO CON	Radiology	73200	CPT	2201111		Washington Regional Medical Center	outpatient	1381	690.5	Original Medicare	Traditional Medicare Fee-for-Service	649.07	197.93	1035.75
CT HAND LT WO CON	CT HAND LT WO CON	Radiology	73200	CPT	2201126		Washington Regional Medical Center	outpatient	1381	690.5	Self-Pay	Discounted Cash		197.93	1035.75
CT HAND LT WO CON	CT HAND LT WO CON	Radiology	73200	CPT	2201126		Washington Regional Medical Center	outpatient	1381	690.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1035.75	197.93	1035.75
CT HAND LT WO CON	CT HAND LT WO CON	Radiology	73200	CPT	2201126		Washington Regional Medical Center	outpatient	1381	690.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	607.64	197.93	1035.75
CT HAND LT WO CON	CT HAND LT WO CON	Radiology	73200	CPT	2201126		Washington Regional Medical Center	outpatient	1381	690.5	Humana	Medicare Advantage HMO/PPO/PFFS	649.07	197.93	1035.75
CT HAND LT WO CON	CT HAND LT WO CON	Radiology	73200	CPT	2201126		Washington Regional Medical Center	outpatient	1381	690.5	AmeriHealth Caritas North Carolina	NC Medicaid	485.56	197.93	1035.75
CT HAND LT WO CON	CT HAND LT WO CON	Radiology	73200	CPT	2201126		Washington Regional Medical Center	outpatient	1381	690.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	485.56	197.93	1035.75
CT HAND LT WO CON	CT HAND LT WO CON	Radiology	73200	CPT	2201126		Washington Regional Medical Center	outpatient	1381	690.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	485.56	197.93	1035.75
CT HAND LT WO CON	CT HAND LT WO CON	Radiology	73200	CPT	2201126		Washington Regional Medical Center	outpatient	1381	690.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	485.56	197.93	1035.75
CT HAND LT WO CON	CT HAND LT WO CON	Radiology	73200	CPT	2201126		Washington Regional Medical Center	outpatient	1381	690.5	Cigna	North Carolina PPO-PPA Direct	197.93	197.93	1035.75
CT HAND LT WO CON	CT HAND LT WO CON	Radiology	73200	CPT	2201126		Washington Regional Medical Center	outpatient	1381	690.5	Original Medicare	Traditional Medicare Fee-for-Service	649.07	197.93	1035.75
CT HAND RT WO CON	CT HAND RT WO CON	Radiology	73200	CPT	2201129		Washington Regional Medical Center	outpatient	1381	690.5	Self-Pay	Discounted Cash		197.93	1035.75
CT HAND RT WO CON	CT HAND RT WO CON	Radiology	73200	CPT	2201129		Washington Regional Medical Center	outpatient	1381	690.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1035.75	197.93	1035.75
CT HAND RT WO CON	CT HAND RT WO CON	Radiology	73200	CPT	2201129		Washington Regional Medical Center	outpatient	1381	690.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	607.64	197.93	1035.75
CT HAND RT WO CON	CT HAND RT WO CON	Radiology	73200	CPT	2201129		Washington Regional Medical Center	outpatient	1381	690.5	Humana	Medicare Advantage HMO/PPO/PFFS	649.07	197.93	1035.75
CT HAND RT WO CON	CT HAND RT WO CON	Radiology	73200	CPT	2201129		Washington Regional Medical Center	outpatient	1381	690.5	AmeriHealth Caritas North Carolina	NC Medicaid	485.56	197.93	1035.75
CT HAND RT WO CON	CT HAND RT WO CON	Radiology	73200	CPT	2201129		Washington Regional Medical Center	outpatient	1381	690.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	485.56	197.93	1035.75
CT HAND RT WO CON	CT HAND RT WO CON	Radiology	73200	CPT	2201129		Washington Regional Medical Center	outpatient	1381	690.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	485.56	197.93	1035.75
CT HAND RT WO CON	CT HAND RT WO CON	Radiology	73200	CPT	2201129		Washington Regional Medical Center	outpatient	1381	690.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	485.56	197.93	1035.75
CT HAND RT WO CON	CT HAND RT WO CON	Radiology	73200	CPT	2201129		Washington Regional Medical Center	outpatient	1381	690.5	Cigna	North Carolina PPO-PPA Direct	197.93	197.93	1035.75
CT HAND RT WO CON	CT HAND RT WO CON	Radiology	73200	CPT	2201129		Washington Regional Medical Center	outpatient	1381	690.5	Original Medicare	Traditional Medicare Fee-for-Service	649.07	197.93	1035.75
CT HIP LT W CON	CT HIP LT W CON	Radiology	73701	CPT	2201132		Washington Regional Medical Center	outpatient	1767	883.5	Self-Pay	Discounted Cash		236.16	1325.25
CT HIP LT W CON	CT HIP LT W CON	Radiology	73701	CPT	2201132		Washington Regional Medical Center	outpatient	1767	883.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1325.25	236.16	1325.25
CT HIP LT W CON	CT HIP LT W CON	Radiology	73701	CPT	2201132		Washington Regional Medical Center	outpatient	1767	883.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	777.48	236.16	1325.25
CT HIP LT W CON	CT HIP LT W CON	Radiology	73701	CPT	2201132		Washington Regional Medical Center	outpatient	1767	883.5	Humana	Medicare Advantage HMO/PPO/PFFS	830.49	236.16	1325.25
CT HIP LT W CON	CT HIP LT W CON	Radiology	73701	CPT	2201132		Washington Regional Medical Center	outpatient	1767	883.5	AmeriHealth Caritas North Carolina	NC Medicaid	621.28	236.16	1325.25
CT HIP LT W CON	CT HIP LT W CON	Radiology	73701	CPT	2201132		Washington Regional Medical Center	outpatient	1767	883.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	621.28	236.16	1325.25
CT HIP LT W CON	CT HIP LT W CON	Radiology	73701	CPT	2201132		Washington Regional Medical Center	outpatient	1767	883.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	621.28	236.16	1325.25
CT HIP LT W CON	CT HIP LT W CON	Radiology	73701	CPT	2201132		Washington Regional Medical Center	outpatient	1767	883.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	621.28	236.16	1325.25
CT HIP LT W CON	CT HIP LT W CON	Radiology	73701	CPT	2201132		Washington Regional Medical Center	outpatient	1767	883.5	Cigna	North Carolina PPO-PPA Direct	236.16	236.16	1325.25
CT HIP LT W CON	CT HIP LT W CON	Radiology	73701	CPT	2201132		Washington Regional Medical Center	outpatient	1767	883.5	Original Medicare	Traditional Medicare Fee-for-Service	830.49	236.16	1325.25
CT HIP RT W CON	CT HIP RT W CON	Radiology	73701	CPT	2201135		Washington Regional Medical Center	outpatient	1767	883.5	Self-Pay	Discounted Cash		236.16	1325.25
CT HIP RT W CON	CT HIP RT W CON	Radiology	73701	CPT	2201135		Washington Regional Medical Center	outpatient	1767	883.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1325.25	236.16	1325.25
CT HIP RT W CON	CT HIP RT W CON	Radiology	73701	CPT	2201135		Washington Regional Medical Center	outpatient	1767	883.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	777.48	236.16	1325.25
CT HIP RT W CON	CT HIP RT W CON	Radiology	73701	CPT	2201135		Washington Regional Medical Center	outpatient	1767	883.5	Humana	Medicare Advantage HMO/PPO/PFFS	830.49	236.16	1325.25
CT HIP RT W CON	CT HIP RT W CON	Radiology	73701	CPT	2201135		Washington Regional Medical Center	outpatient	1767	883.5	AmeriHealth Caritas North Carolina	NC Medicaid	621.28	236.16	1325.25
CT HIP RT W CON	CT HIP RT W CON	Radiology	73701	CPT	2201135		Washington Regional Medical Center	outpatient	1767	883.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	621.28	236.16	1325.25
CT HIP RT W CON	CT HIP RT W CON	Radiology	73701	CPT	2201135		Washington Regional Medical Center	outpatient	1767	883.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	621.28	236.16	1325.25
CT HIP RT W CON	CT HIP RT W CON	Radiology	73701	CPT	2201135		Washington Regional Medical Center	outpatient	1767	883.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	621.28	236.16	1325.25
CT HIP RT W CON	CT HIP RT W CON	Radiology	73701	CPT	2201135		Washington Regional Medical Center	outpatient	1767	883.5	Cigna	North Carolina PPO-PPA Direct	236.16	236.16	1325.25
CT HIP RT W CON	CT HIP RT W CON	Radiology	73701	CPT	2201135		Washington Regional Medical Center	outpatient	1767	883.5	Original Medicare	Traditional Medicare Fee-for-Service	830.49	236.16	1325.25
CT HUMERUS LT WO CON	CT HUMERUS LT WO CON	Radiology	73200	CPT	2201139		Washington Regional Medical Center	outpatient	1381	690.5	Self-Pay	Discounted Cash		197.93	1035.75
CT HUMERUS LT WO CON	CT HUMERUS LT WO CON	Radiology	73200	CPT	2201139		Washington Regional Medical Center	outpatient	1381	690.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1035.75	197.93	1035.75
CT HUMERUS LT WO CON	CT HUMERUS LT WO CON	Radiology	73200	CPT	2201139		Washington Regional Medical Center	outpatient	1381	690.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	607.64	197.93	1035.75
CT HUMERUS LT WO CON	CT HUMERUS LT WO CON	Radiology	73200	CPT	2201139		Washington Regional Medical Center	outpatient	1381	690.5	Humana	Medicare Advantage HMO/PPO/PFFS	649.07	197.93	1035.75
CT HUMERUS LT WO CON	CT HUMERUS LT WO CON	Radiology	73200	CPT	2201139		Washington Regional Medical Center	outpatient	1381	690.5	AmeriHealth Caritas North Carolina	NC Medicaid	485.56	197.93	1035.75
CT HUMERUS LT WO CON	CT HUMERUS LT WO CON	Radiology	73200	CPT	2201139		Washington Regional Medical Center	outpatient	1381	690.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	485.56	197.93	1035.75
CT HUMERUS LT WO CON	CT HUMERUS LT WO CON	Radiology	73200	CPT	2201139		Washington Regional Medical Center	outpatient	1381	690.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	485.56	197.93	1035.75
CT HUMERUS LT WO CON	CT HUMERUS LT WO CON	Radiology	73200	CPT	2201139		Washington Regional Medical Center	outpatient	1381	690.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	485.56	197.93	1035.75
CT HUMERUS LT WO CON	CT HUMERUS LT WO CON	Radiology	73200	CPT	2201139		Washington Regional Medical Center	outpatient	1381	690.5	Cigna	North Carolina PPO-PPA Direct	197.93	197.93	1035.75
CT HUMERUS LT WO CON	CT HUMERUS LT WO CON	Radiology	73200	CPT	2201139		Washington Regional Medical Center	outpatient	1381	690.5	Original Medicare	Traditional Medicare Fee-for-Service	649.07	197.93	1035.75
CT HUMERUS RT WO CON	CT HUMERUS RT WO CON	Radiology	73200	CPT	2201142		Washington Regional Medical Center	outpatient	1381	690.5	Self-Pay	Discounted Cash		197.93	1035.75
CT HUMERUS RT WO CON	CT HUMERUS RT WO CON	Radiology	73200	CPT	2201142		Washington Regional Medical Center	outpatient	1381	690.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1035.75	197.93	1035.75
CT HUMERUS RT WO CON	CT HUMERUS RT WO CON	Radiology	73200	CPT	2201142		Washington Regional Medical Center	outpatient	1381	690.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	607.64	197.93	1035.75
CT HUMERUS RT WO CON	CT HUMERUS RT WO CON	Radiology	73200	CPT	2201142		Washington Regional Medical Center	outpatient	1381	690.5	Humana	Medicare Advantage HMO/PPO/PFFS	649.07	197.93	1035.75
CT HUMERUS RT WO CON	CT HUMERUS RT WO CON	Radiology	73200	CPT	2201142		Washington Regional Medical Center	outpatient	1381	690.5	AmeriHealth Caritas North Carolina	NC Medicaid	485.56	197.93	1035.75
CT HUMERUS RT WO CON	CT HUMERUS RT WO CON	Radiology	73200	CPT	2201142		Washington Regional Medical Center	outpatient	1381	690.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	485.56	197.93	1035.75
CT HUMERUS RT WO CON	CT HUMERUS RT WO CON	Radiology	73200	CPT	2201142		Washington Regional Medical Center	outpatient	1381	690.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	485.56	197.93	1035.75
CT HUMERUS RT WO CON	CT HUMERUS RT WO CON	Radiology	73200	CPT	2201142		Washington Regional Medical Center	outpatient	1381	690.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	485.56	197.93	1035.75
CT HUMERUS RT WO CON	CT HUMERUS RT WO CON	Radiology	73200	CPT	2201142		Washington Regional Medical Center	outpatient	1381	690.5	Cigna	North Carolina PPO-PPA Direct	197.93	197.93	1035.75
CT HUMERUS RT WO CON	CT HUMERUS RT WO CON	Radiology	73200	CPT	2201142		Washington Regional Medical Center	outpatient	1381	690.5	Original Medicare	Traditional Medicare Fee-for-Service	649.07	197.93	1035.75
CT KNEE LT W CON	CT KNEE LT W CON	Radiology	73701	CPT	2201144		Washington Regional Medical Center	outpatient	1767	883.5	Self-Pay	Discounted Cash		236.16	1325.25
CT KNEE LT W CON	CT KNEE LT W CON	Radiology	73701	CPT	2201144		Washington Regional Medical Center	outpatient	1767	883.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1325.25	236.16	1325.25
CT KNEE LT W CON	CT KNEE LT W CON	Radiology	73701	CPT	2201144		Washington Regional Medical Center	outpatient	1767	883.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	777.48	236.16	1325.25
CT KNEE LT W CON	CT KNEE LT W CON	Radiology	73701	CPT	2201144		Washington Regional Medical Center	outpatient	1767	883.5	Humana	Medicare Advantage HMO/PPO/PFFS	830.49	236.16	1325.25
CT KNEE LT W CON	CT KNEE LT W CON	Radiology	73701	CPT	2201144		Washington Regional Medical Center	outpatient	1767	883.5	AmeriHealth Caritas North Carolina	NC Medicaid	621.28	236.16	1325.25
CT KNEE LT W CON	CT KNEE LT W CON	Radiology	73701	CPT	2201144		Washington Regional Medical Center	outpatient	1767	883.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	621.28	236.16	1325.25
CT KNEE LT W CON	CT KNEE LT W CON	Radiology	73701	CPT	2201144		Washington Regional Medical Center	outpatient	1767	883.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	621.28	236.16	1325.25
CT KNEE LT W CON	CT KNEE LT W CON	Radiology	73701	CPT	2201144		Washington Regional Medical Center	outpatient	1767	883.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	621.28	236.16	1325.25
CT KNEE LT W CON	CT KNEE LT W CON	Radiology	73701	CPT	2201144		Washington Regional Medical Center	outpatient	1767	883.5	Cigna	North Carolina PPO-PPA Direct	236.16	236.16	1325.25
CT KNEE LT W CON	CT KNEE LT W CON	Radiology	73701	CPT	2201144		Washington Regional Medical Center	outpatient	1767	883.5	Original Medicare	Traditional Medicare Fee-for-Service	830.49	236.16	1325.25
CT KNEE RT W CON	CT KNEE RT W CON	Radiology	73701	CPT	2201147		Washington Regional Medical Center	outpatient	1767	883.5	Self-Pay	Discounted Cash		236.16	1325.25
CT KNEE RT W CON	CT KNEE RT W CON	Radiology	73701	CPT	2201147		Washington Regional Medical Center	outpatient	1767	883.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1325.25	236.16	1325.25
CT KNEE RT W CON	CT KNEE RT W CON	Radiology	73701	CPT	2201147		Washington Regional Medical Center	outpatient	1767	883.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	777.48	236.16	1325.25
CT KNEE RT W CON	CT KNEE RT W CON	Radiology	73701	CPT	2201147		Washington Regional Medical Center	outpatient	1767	883.5	Humana	Medicare Advantage HMO/PPO/PFFS	830.49	236.16	1325.25
CT KNEE RT W CON	CT KNEE RT W CON	Radiology	73701	CPT	2201147		Washington Regional Medical Center	outpatient	1767	883.5	AmeriHealth Caritas North Carolina	NC Medicaid	621.28	236.16	1325.25
CT KNEE RT W CON	CT KNEE RT W CON	Radiology	73701	CPT	2201147		Washington Regional Medical Center	outpatient	1767	883.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	621.28	236.16	1325.25
CT KNEE RT W CON	CT KNEE RT W CON	Radiology	73701	CPT	2201147		Washington Regional Medical Center	outpatient	1767	883.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	621.28	236.16	1325.25
CT KNEE RT W CON	CT KNEE RT W CON	Radiology	73701	CPT	2201147		Washington Regional Medical Center	outpatient	1767	883.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	621.28	236.16	1325.25
CT KNEE RT W CON	CT KNEE RT W CON	Radiology	73701	CPT	2201147		Washington Regional Medical Center	outpatient	1767	883.5	Cigna	North Carolina PPO-PPA Direct	236.16	236.16	1325.25
CT KNEE RT W CON	CT KNEE RT W CON	Radiology	73701	CPT	2201147		Washington Regional Medical Center	outpatient	1767	883.5	Original Medicare	Traditional Medicare Fee-for-Service	830.49	236.16	1325.25
CT LOW LEG LT W CON	CT LOW LEG LT W CON	Radiology	73701	CPT	2201150		Washington Regional Medical Center	outpatient	1767	883.5	Self-Pay	Discounted Cash		236.16	1325.25
CT LOW LEG LT W CON	CT LOW LEG LT W CON	Radiology	73701	CPT	2201150		Washington Regional Medical Center	outpatient	1767	883.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1325.25	236.16	1325.25
CT LOW LEG LT W CON	CT LOW LEG LT W CON	Radiology	73701	CPT	2201150		Washington Regional Medical Center	outpatient	1767	883.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	777.48	236.16	1325.25
CT LOW LEG LT W CON	CT LOW LEG LT W CON	Radiology	73701	CPT	2201150		Washington Regional Medical Center	outpatient	1767	883.5	Humana	Medicare Advantage HMO/PPO/PFFS	830.49	236.16	1325.25
CT LOW LEG LT W CON	CT LOW LEG LT W CON	Radiology	73701	CPT	2201150		Washington Regional Medical Center	outpatient	1767	883.5	AmeriHealth Caritas North Carolina	NC Medicaid	621.28	236.16	1325.25
CT LOW LEG LT W CON	CT LOW LEG LT W CON	Radiology	73701	CPT	2201150		Washington Regional Medical Center	outpatient	1767	883.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	621.28	236.16	1325.25
CT LOW LEG LT W CON	CT LOW LEG LT W CON	Radiology	73701	CPT	2201150		Washington Regional Medical Center	outpatient	1767	883.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	621.28	236.16	1325.25
CT LOW LEG LT W CON	CT LOW LEG LT W CON	Radiology	73701	CPT	2201150		Washington Regional Medical Center	outpatient	1767	883.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	621.28	236.16	1325.25
CT LOW LEG LT W CON	CT LOW LEG LT W CON	Radiology	73701	CPT	2201150		Washington Regional Medical Center	outpatient	1767	883.5	Cigna	North Carolina PPO-PPA Direct	236.16	236.16	1325.25
CT LOW LEG LT W CON	CT LOW LEG LT W CON	Radiology	73701	CPT	2201150		Washington Regional Medical Center	outpatient	1767	883.5	Original Medicare	Traditional Medicare Fee-for-Service	830.49	236.16	1325.25
CT LOW LEG RT W CON	CT LOW LEG RT W CON	Radiology	73701	CPT	2201153		Washington Regional Medical Center	outpatient	1767	883.5	Self-Pay	Discounted Cash		236.16	1325.25
CT LOW LEG RT W CON	CT LOW LEG RT W CON	Radiology	73701	CPT	2201153		Washington Regional Medical Center	outpatient	1767	883.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1325.25	236.16	1325.25
CT LOW LEG RT W CON	CT LOW LEG RT W CON	Radiology	73701	CPT	2201153		Washington Regional Medical Center	outpatient	1767	883.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	777.48	236.16	1325.25
CT LOW LEG RT W CON	CT LOW LEG RT W CON	Radiology	73701	CPT	2201153		Washington Regional Medical Center	outpatient	1767	883.5	Humana	Medicare Advantage HMO/PPO/PFFS	830.49	236.16	1325.25
CT LOW LEG RT W CON	CT LOW LEG RT W CON	Radiology	73701	CPT	2201153		Washington Regional Medical Center	outpatient	1767	883.5	AmeriHealth Caritas North Carolina	NC Medicaid	621.28	236.16	1325.25
CT LOW LEG RT W CON	CT LOW LEG RT W CON	Radiology	73701	CPT	2201153		Washington Regional Medical Center	outpatient	1767	883.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	621.28	236.16	1325.25
CT LOW LEG RT W CON	CT LOW LEG RT W CON	Radiology	73701	CPT	2201153		Washington Regional Medical Center	outpatient	1767	883.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	621.28	236.16	1325.25
CT LOW LEG RT W CON	CT LOW LEG RT W CON	Radiology	73701	CPT	2201153		Washington Regional Medical Center	outpatient	1767	883.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	621.28	236.16	1325.25
CT LOW LEG RT W CON	CT LOW LEG RT W CON	Radiology	73701	CPT	2201153		Washington Regional Medical Center	outpatient	1767	883.5	Cigna	North Carolina PPO-PPA Direct	236.16	236.16	1325.25
CT LOW LEG RT W CON	CT LOW LEG RT W CON	Radiology	73701	CPT	2201153		Washington Regional Medical Center	outpatient	1767	883.5	Original Medicare	Traditional Medicare Fee-for-Service	830.49	236.16	1325.25
CT LOWER EXT W/C LT	CT LOWER EXT W/C LT	Radiology	73701	CPT	2201043		Washington Regional Medical Center	outpatient	1767	883.5	Self-Pay	Discounted Cash		236.16	1325.25
CT LOWER EXT W/C LT	CT LOWER EXT W/C LT	Radiology	73701	CPT	2201043		Washington Regional Medical Center	outpatient	1767	883.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1325.25	236.16	1325.25
CT LOWER EXT W/C LT	CT LOWER EXT W/C LT	Radiology	73701	CPT	2201043		Washington Regional Medical Center	outpatient	1767	883.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	777.48	236.16	1325.25
CT LOWER EXT W/C LT	CT LOWER EXT W/C LT	Radiology	73701	CPT	2201043		Washington Regional Medical Center	outpatient	1767	883.5	Humana	Medicare Advantage HMO/PPO/PFFS	830.49	236.16	1325.25
CT LOWER EXT W/C LT	CT LOWER EXT W/C LT	Radiology	73701	CPT	2201043		Washington Regional Medical Center	outpatient	1767	883.5	AmeriHealth Caritas North Carolina	NC Medicaid	621.28	236.16	1325.25
CT LOWER EXT W/C LT	CT LOWER EXT W/C LT	Radiology	73701	CPT	2201043		Washington Regional Medical Center	outpatient	1767	883.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	621.28	236.16	1325.25
CT LOWER EXT W/C LT	CT LOWER EXT W/C LT	Radiology	73701	CPT	2201043		Washington Regional Medical Center	outpatient	1767	883.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	621.28	236.16	1325.25
CT LOWER EXT W/C LT	CT LOWER EXT W/C LT	Radiology	73701	CPT	2201043		Washington Regional Medical Center	outpatient	1767	883.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	621.28	236.16	1325.25
CT LOWER EXT W/C LT	CT LOWER EXT W/C LT	Radiology	73701	CPT	2201043		Washington Regional Medical Center	outpatient	1767	883.5	Cigna	North Carolina PPO-PPA Direct	236.16	236.16	1325.25
CT LOWER EXT W/C LT	CT LOWER EXT W/C LT	Radiology	73701	CPT	2201043		Washington Regional Medical Center	outpatient	1767	883.5	Original Medicare	Traditional Medicare Fee-for-Service	830.49	236.16	1325.25
CT LOWER EXT W/C RT	CT LOWER EXT W/C RT	Radiology	73701	CPT	2201044		Washington Regional Medical Center	outpatient	1767	883.5	Self-Pay	Discounted Cash		236.16	1325.25
CT LOWER EXT W/C RT	CT LOWER EXT W/C RT	Radiology	73701	CPT	2201044		Washington Regional Medical Center	outpatient	1767	883.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1325.25	236.16	1325.25
CT LOWER EXT W/C RT	CT LOWER EXT W/C RT	Radiology	73701	CPT	2201044		Washington Regional Medical Center	outpatient	1767	883.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	777.48	236.16	1325.25
CT LOWER EXT W/C RT	CT LOWER EXT W/C RT	Radiology	73701	CPT	2201044		Washington Regional Medical Center	outpatient	1767	883.5	Humana	Medicare Advantage HMO/PPO/PFFS	830.49	236.16	1325.25
CT LOWER EXT W/C RT	CT LOWER EXT W/C RT	Radiology	73701	CPT	2201044		Washington Regional Medical Center	outpatient	1767	883.5	AmeriHealth Caritas North Carolina	NC Medicaid	621.28	236.16	1325.25
CT LOWER EXT W/C RT	CT LOWER EXT W/C RT	Radiology	73701	CPT	2201044		Washington Regional Medical Center	outpatient	1767	883.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	621.28	236.16	1325.25
CT LOWER EXT W/C RT	CT LOWER EXT W/C RT	Radiology	73701	CPT	2201044		Washington Regional Medical Center	outpatient	1767	883.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	621.28	236.16	1325.25
CT LOWER EXT W/C RT	CT LOWER EXT W/C RT	Radiology	73701	CPT	2201044		Washington Regional Medical Center	outpatient	1767	883.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	621.28	236.16	1325.25
CT LOWER EXT W/C RT	CT LOWER EXT W/C RT	Radiology	73701	CPT	2201044		Washington Regional Medical Center	outpatient	1767	883.5	Cigna	North Carolina PPO-PPA Direct	236.16	236.16	1325.25
CT LOWER EXT W/C RT	CT LOWER EXT W/C RT	Radiology	73701	CPT	2201044		Washington Regional Medical Center	outpatient	1767	883.5	Original Medicare	Traditional Medicare Fee-for-Service	830.49	236.16	1325.25
CT ORBIT/EAR/FOSSA WO/C	CT ORBIT/EAR/FOSSA WO/C	Radiology	70480	CPT	2201016		Washington Regional Medical Center	outpatient	1417	708.5	Self-Pay	Discounted Cash		188.68	1062.75
CT ORBIT/EAR/FOSSA WO/C	CT ORBIT/EAR/FOSSA WO/C	Radiology	70480	CPT	2201016		Washington Regional Medical Center	outpatient	1417	708.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1062.75	188.68	1062.75
CT ORBIT/EAR/FOSSA WO/C	CT ORBIT/EAR/FOSSA WO/C	Radiology	70480	CPT	2201016		Washington Regional Medical Center	outpatient	1417	708.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	623.48	188.68	1062.75
CT ORBIT/EAR/FOSSA WO/C	CT ORBIT/EAR/FOSSA WO/C	Radiology	70480	CPT	2201016		Washington Regional Medical Center	outpatient	1417	708.5	Humana	Medicare Advantage HMO/PPO/PFFS	665.99	188.68	1062.75
CT ORBIT/EAR/FOSSA WO/C	CT ORBIT/EAR/FOSSA WO/C	Radiology	70480	CPT	2201016		Washington Regional Medical Center	outpatient	1417	708.5	AmeriHealth Caritas North Carolina	NC Medicaid	498.22	188.68	1062.75
CT ORBIT/EAR/FOSSA WO/C	CT ORBIT/EAR/FOSSA WO/C	Radiology	70480	CPT	2201016		Washington Regional Medical Center	outpatient	1417	708.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	498.22	188.68	1062.75
CT ORBIT/EAR/FOSSA WO/C	CT ORBIT/EAR/FOSSA WO/C	Radiology	70480	CPT	2201016		Washington Regional Medical Center	outpatient	1417	708.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	498.22	188.68	1062.75
CT ORBIT/EAR/FOSSA WO/C	CT ORBIT/EAR/FOSSA WO/C	Radiology	70480	CPT	2201016		Washington Regional Medical Center	outpatient	1417	708.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	498.22	188.68	1062.75
CT ORBIT/EAR/FOSSA WO/C	CT ORBIT/EAR/FOSSA WO/C	Radiology	70480	CPT	2201016		Washington Regional Medical Center	outpatient	1417	708.5	Cigna	North Carolina PPO-PPA Direct	188.68	188.68	1062.75
CT ORBIT/EAR/FOSSA WO/C	CT ORBIT/EAR/FOSSA WO/C	Radiology	70480	CPT	2201016		Washington Regional Medical Center	outpatient	1417	708.5	Original Medicare	Traditional Medicare Fee-for-Service	665.99	188.68	1062.75
CT scan of abdomen and pelvis with contrast	CT ABD PELV W/C	Radiology	74177	CPT	2201089		Washington Regional Medical Center	outpatient	5148	2574	Self-Pay	Discounted Cash		285.23	3861
CT scan of abdomen and pelvis with contrast	CT ABD PELV W/C	Radiology	74177	CPT	2201089		Washington Regional Medical Center	outpatient	5148	2574	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	3861	285.23	3861
CT scan of abdomen and pelvis with contrast	CT ABD PELV W/C	Radiology	74177	CPT	2201089		Washington Regional Medical Center	outpatient	5148	2574	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	2265.12	285.23	3861
CT scan of abdomen and pelvis with contrast	CT ABD PELV W/C	Radiology	74177	CPT	2201089		Washington Regional Medical Center	outpatient	5148	2574	Humana	Medicare Advantage HMO/PPO/PFFS	2419.56	285.23	3861
CT scan of abdomen and pelvis with contrast	CT ABD PELV W/C	Radiology	74177	CPT	2201089		Washington Regional Medical Center	outpatient	5148	2574	AmeriHealth Caritas North Carolina	NC Medicaid	1810.04	285.23	3861
CT scan of abdomen and pelvis with contrast	CT ABD PELV W/C	Radiology	74177	CPT	2201089		Washington Regional Medical Center	outpatient	5148	2574	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	1810.04	285.23	3861
CT scan of abdomen and pelvis with contrast	CT ABD PELV W/C	Radiology	74177	CPT	2201089		Washington Regional Medical Center	outpatient	5148	2574	WellCare of North Carolina	North Carolina Medicaid/CHIP	1810.04	285.23	3861
CT scan of abdomen and pelvis with contrast	CT ABD PELV W/C	Radiology	74177	CPT	2201089		Washington Regional Medical Center	outpatient	5148	2574	Healthy Blue / Blue Cross NC	North Carolina Medicaid	1810.04	285.23	3861
CT scan of abdomen and pelvis with contrast	CT ABD PELV W/C	Radiology	74177	CPT	2201089		Washington Regional Medical Center	outpatient	5148	2574	Cigna	North Carolina PPO-PPA Direct	285.23	285.23	3861
CT scan of abdomen and pelvis with contrast	CT ABD PELV W/C	Radiology	74177	CPT	2201089		Washington Regional Medical Center	outpatient	5148	2574	Original Medicare	Traditional Medicare Fee-for-Service	2419.56	285.23	3861
CT scan, head or brain, without contrast	CT HEAD WO/C	Radiology	70450	CPT	2201019		Washington Regional Medical Center	outpatient	2106	1053	Self-Pay	Discounted Cash		188.68	1579.5
CT scan, head or brain, without contrast	CT HEAD WO/C	Radiology	70450	CPT	2201019		Washington Regional Medical Center	outpatient	2106	1053	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1579.5	188.68	1579.5
CT scan, head or brain, without contrast	CT HEAD WO/C	Radiology	70450	CPT	2201019		Washington Regional Medical Center	outpatient	2106	1053	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	926.64	188.68	1579.5
CT scan, head or brain, without contrast	CT HEAD WO/C	Radiology	70450	CPT	2201019		Washington Regional Medical Center	outpatient	2106	1053	Humana	Medicare Advantage HMO/PPO/PFFS	989.82	188.68	1579.5
CT scan, head or brain, without contrast	CT HEAD WO/C	Radiology	70450	CPT	2201019		Washington Regional Medical Center	outpatient	2106	1053	AmeriHealth Caritas North Carolina	NC Medicaid	740.47	188.68	1579.5
CT scan, head or brain, without contrast	CT HEAD WO/C	Radiology	70450	CPT	2201019		Washington Regional Medical Center	outpatient	2106	1053	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	740.47	188.68	1579.5
CT scan, head or brain, without contrast	CT HEAD WO/C	Radiology	70450	CPT	2201019		Washington Regional Medical Center	outpatient	2106	1053	WellCare of North Carolina	North Carolina Medicaid/CHIP	740.47	188.68	1579.5
CT scan, head or brain, without contrast	CT HEAD WO/C	Radiology	70450	CPT	2201019		Washington Regional Medical Center	outpatient	2106	1053	Healthy Blue / Blue Cross NC	North Carolina Medicaid	740.47	188.68	1579.5
CT scan, head or brain, without contrast	CT HEAD WO/C	Radiology	70450	CPT	2201019		Washington Regional Medical Center	outpatient	2106	1053	Cigna	North Carolina PPO-PPA Direct	188.68	188.68	1579.5
CT scan, head or brain, without contrast	CT HEAD WO/C	Radiology	70450	CPT	2201019		Washington Regional Medical Center	outpatient	2106	1053	Original Medicare	Traditional Medicare Fee-for-Service	989.82	188.68	1579.5
CT scan, pelvis, with contrast	CT PELVIS W/C	Radiology	72193	CPT	2201028		Washington Regional Medical Center	outpatient	2761	1380.5	Self-Pay	Discounted Cash		273.36	2070.75
CT scan, pelvis, with contrast	CT PELVIS W/C	Radiology	72193	CPT	2201028		Washington Regional Medical Center	outpatient	2761	1380.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	2070.75	273.36	2070.75
CT scan, pelvis, with contrast	CT PELVIS W/C	Radiology	72193	CPT	2201028		Washington Regional Medical Center	outpatient	2761	1380.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	1214.84	273.36	2070.75
CT scan, pelvis, with contrast	CT PELVIS W/C	Radiology	72193	CPT	2201028		Washington Regional Medical Center	outpatient	2761	1380.5	Humana	Medicare Advantage HMO/PPO/PFFS	1297.67	273.36	2070.75
CT scan, pelvis, with contrast	CT PELVIS W/C	Radiology	72193	CPT	2201028		Washington Regional Medical Center	outpatient	2761	1380.5	AmeriHealth Caritas North Carolina	NC Medicaid	970.77	273.36	2070.75
CT scan, pelvis, with contrast	CT PELVIS W/C	Radiology	72193	CPT	2201028		Washington Regional Medical Center	outpatient	2761	1380.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	970.77	273.36	2070.75
CT scan, pelvis, with contrast	CT PELVIS W/C	Radiology	72193	CPT	2201028		Washington Regional Medical Center	outpatient	2761	1380.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	970.77	273.36	2070.75
CT scan, pelvis, with contrast	CT PELVIS W/C	Radiology	72193	CPT	2201028		Washington Regional Medical Center	outpatient	2761	1380.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	970.77	273.36	2070.75
CT scan, pelvis, with contrast	CT PELVIS W/C	Radiology	72193	CPT	2201028		Washington Regional Medical Center	outpatient	2761	1380.5	Cigna	North Carolina PPO-PPA Direct	273.36	273.36	2070.75
CT scan, pelvis, with contrast	CT PELVIS W/C	Radiology	72193	CPT	2201028		Washington Regional Medical Center	outpatient	2761	1380.5	Original Medicare	Traditional Medicare Fee-for-Service	1297.67	273.36	2070.75
CT SCAPULA LT	CT SCAPULA LT	Radiology	73200	CPT	2201158		Washington Regional Medical Center	outpatient	1381	690.5	Self-Pay	Discounted Cash		197.93	1035.75
CT SCAPULA LT	CT SCAPULA LT	Radiology	73200	CPT	2201158		Washington Regional Medical Center	outpatient	1381	690.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1035.75	197.93	1035.75
CT SCAPULA LT	CT SCAPULA LT	Radiology	73200	CPT	2201158		Washington Regional Medical Center	outpatient	1381	690.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	607.64	197.93	1035.75
CT SCAPULA LT	CT SCAPULA LT	Radiology	73200	CPT	2201158		Washington Regional Medical Center	outpatient	1381	690.5	Humana	Medicare Advantage HMO/PPO/PFFS	649.07	197.93	1035.75
CT SCAPULA LT	CT SCAPULA LT	Radiology	73200	CPT	2201158		Washington Regional Medical Center	outpatient	1381	690.5	AmeriHealth Caritas North Carolina	NC Medicaid	485.56	197.93	1035.75
CT SCAPULA LT	CT SCAPULA LT	Radiology	73200	CPT	2201158		Washington Regional Medical Center	outpatient	1381	690.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	485.56	197.93	1035.75
CT SCAPULA LT	CT SCAPULA LT	Radiology	73200	CPT	2201158		Washington Regional Medical Center	outpatient	1381	690.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	485.56	197.93	1035.75
CT SCAPULA LT	CT SCAPULA LT	Radiology	73200	CPT	2201158		Washington Regional Medical Center	outpatient	1381	690.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	485.56	197.93	1035.75
CT SCAPULA LT	CT SCAPULA LT	Radiology	73200	CPT	2201158		Washington Regional Medical Center	outpatient	1381	690.5	Cigna	North Carolina PPO-PPA Direct	197.93	197.93	1035.75
CT SCAPULA LT	CT SCAPULA LT	Radiology	73200	CPT	2201158		Washington Regional Medical Center	outpatient	1381	690.5	Original Medicare	Traditional Medicare Fee-for-Service	649.07	197.93	1035.75
CT SCAPULA RT	CT SCAPULA RT	Radiology	73200	CPT	2201159		Washington Regional Medical Center	outpatient	1381	690.5	Self-Pay	Discounted Cash		197.93	1035.75
CT SCAPULA RT	CT SCAPULA RT	Radiology	73200	CPT	2201159		Washington Regional Medical Center	outpatient	1381	690.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1035.75	197.93	1035.75
CT SCAPULA RT	CT SCAPULA RT	Radiology	73200	CPT	2201159		Washington Regional Medical Center	outpatient	1381	690.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	607.64	197.93	1035.75
CT SCAPULA RT	CT SCAPULA RT	Radiology	73200	CPT	2201159		Washington Regional Medical Center	outpatient	1381	690.5	Humana	Medicare Advantage HMO/PPO/PFFS	649.07	197.93	1035.75
CT SCAPULA RT	CT SCAPULA RT	Radiology	73200	CPT	2201159		Washington Regional Medical Center	outpatient	1381	690.5	AmeriHealth Caritas North Carolina	NC Medicaid	485.56	197.93	1035.75
CT SCAPULA RT	CT SCAPULA RT	Radiology	73200	CPT	2201159		Washington Regional Medical Center	outpatient	1381	690.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	485.56	197.93	1035.75
CT SCAPULA RT	CT SCAPULA RT	Radiology	73200	CPT	2201159		Washington Regional Medical Center	outpatient	1381	690.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	485.56	197.93	1035.75
CT SCAPULA RT	CT SCAPULA RT	Radiology	73200	CPT	2201159		Washington Regional Medical Center	outpatient	1381	690.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	485.56	197.93	1035.75
CT SCAPULA RT	CT SCAPULA RT	Radiology	73200	CPT	2201159		Washington Regional Medical Center	outpatient	1381	690.5	Cigna	North Carolina PPO-PPA Direct	197.93	197.93	1035.75
CT SCAPULA RT	CT SCAPULA RT	Radiology	73200	CPT	2201159		Washington Regional Medical Center	outpatient	1381	690.5	Original Medicare	Traditional Medicare Fee-for-Service	649.07	197.93	1035.75
CT SHOULDER LT WO CON	CT SHOULDER LT WO CON	Radiology	73200	CPT	2201161		Washington Regional Medical Center	outpatient	1381	690.5	Self-Pay	Discounted Cash		197.93	1035.75
CT SHOULDER LT WO CON	CT SHOULDER LT WO CON	Radiology	73200	CPT	2201161		Washington Regional Medical Center	outpatient	1381	690.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1035.75	197.93	1035.75
CT SHOULDER LT WO CON	CT SHOULDER LT WO CON	Radiology	73200	CPT	2201161		Washington Regional Medical Center	outpatient	1381	690.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	607.64	197.93	1035.75
CT SHOULDER LT WO CON	CT SHOULDER LT WO CON	Radiology	73200	CPT	2201161		Washington Regional Medical Center	outpatient	1381	690.5	Humana	Medicare Advantage HMO/PPO/PFFS	649.07	197.93	1035.75
CT SHOULDER LT WO CON	CT SHOULDER LT WO CON	Radiology	73200	CPT	2201161		Washington Regional Medical Center	outpatient	1381	690.5	AmeriHealth Caritas North Carolina	NC Medicaid	485.56	197.93	1035.75
CT SHOULDER LT WO CON	CT SHOULDER LT WO CON	Radiology	73200	CPT	2201161		Washington Regional Medical Center	outpatient	1381	690.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	485.56	197.93	1035.75
CT SHOULDER LT WO CON	CT SHOULDER LT WO CON	Radiology	73200	CPT	2201161		Washington Regional Medical Center	outpatient	1381	690.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	485.56	197.93	1035.75
CT SHOULDER LT WO CON	CT SHOULDER LT WO CON	Radiology	73200	CPT	2201161		Washington Regional Medical Center	outpatient	1381	690.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	485.56	197.93	1035.75
CT SHOULDER LT WO CON	CT SHOULDER LT WO CON	Radiology	73200	CPT	2201161		Washington Regional Medical Center	outpatient	1381	690.5	Cigna	North Carolina PPO-PPA Direct	197.93	197.93	1035.75
CT SHOULDER LT WO CON	CT SHOULDER LT WO CON	Radiology	73200	CPT	2201161		Washington Regional Medical Center	outpatient	1381	690.5	Original Medicare	Traditional Medicare Fee-for-Service	649.07	197.93	1035.75
CT SHOULDER RT WO CON	CT SHOULDER RT WO CON	Radiology	73200	CPT	2201164		Washington Regional Medical Center	outpatient	1381	690.5	Self-Pay	Discounted Cash		197.93	1035.75
CT SHOULDER RT WO CON	CT SHOULDER RT WO CON	Radiology	73200	CPT	2201164		Washington Regional Medical Center	outpatient	1381	690.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1035.75	197.93	1035.75
CT SHOULDER RT WO CON	CT SHOULDER RT WO CON	Radiology	73200	CPT	2201164		Washington Regional Medical Center	outpatient	1381	690.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	607.64	197.93	1035.75
CT SHOULDER RT WO CON	CT SHOULDER RT WO CON	Radiology	73200	CPT	2201164		Washington Regional Medical Center	outpatient	1381	690.5	Humana	Medicare Advantage HMO/PPO/PFFS	649.07	197.93	1035.75
CT SHOULDER RT WO CON	CT SHOULDER RT WO CON	Radiology	73200	CPT	2201164		Washington Regional Medical Center	outpatient	1381	690.5	AmeriHealth Caritas North Carolina	NC Medicaid	485.56	197.93	1035.75
CT SHOULDER RT WO CON	CT SHOULDER RT WO CON	Radiology	73200	CPT	2201164		Washington Regional Medical Center	outpatient	1381	690.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	485.56	197.93	1035.75
CT SHOULDER RT WO CON	CT SHOULDER RT WO CON	Radiology	73200	CPT	2201164		Washington Regional Medical Center	outpatient	1381	690.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	485.56	197.93	1035.75
CT SHOULDER RT WO CON	CT SHOULDER RT WO CON	Radiology	73200	CPT	2201164		Washington Regional Medical Center	outpatient	1381	690.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	485.56	197.93	1035.75
CT SHOULDER RT WO CON	CT SHOULDER RT WO CON	Radiology	73200	CPT	2201164		Washington Regional Medical Center	outpatient	1381	690.5	Cigna	North Carolina PPO-PPA Direct	197.93	197.93	1035.75
CT SHOULDER RT WO CON	CT SHOULDER RT WO CON	Radiology	73200	CPT	2201164		Washington Regional Medical Center	outpatient	1381	690.5	Original Medicare	Traditional Medicare Fee-for-Service	649.07	197.93	1035.75
CT SINUSES COMP W/WO C	CT SINUSES COMP W/WO C	Radiology	70488	CPT	2201032		Washington Regional Medical Center	outpatient	1737	868.5	Self-Pay	Discounted Cash		282.5	1302.75
CT SINUSES COMP W/WO C	CT SINUSES COMP W/WO C	Radiology	70488	CPT	2201032		Washington Regional Medical Center	outpatient	1737	868.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1302.75	282.5	1302.75
CT SINUSES COMP W/WO C	CT SINUSES COMP W/WO C	Radiology	70488	CPT	2201032		Washington Regional Medical Center	outpatient	1737	868.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	764.28	282.5	1302.75
CT SINUSES COMP W/WO C	CT SINUSES COMP W/WO C	Radiology	70488	CPT	2201032		Washington Regional Medical Center	outpatient	1737	868.5	Humana	Medicare Advantage HMO/PPO/PFFS	816.39	282.5	1302.75
CT SINUSES COMP W/WO C	CT SINUSES COMP W/WO C	Radiology	70488	CPT	2201032		Washington Regional Medical Center	outpatient	1737	868.5	AmeriHealth Caritas North Carolina	NC Medicaid	610.73	282.5	1302.75
CT SINUSES COMP W/WO C	CT SINUSES COMP W/WO C	Radiology	70488	CPT	2201032		Washington Regional Medical Center	outpatient	1737	868.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	610.73	282.5	1302.75
CT SINUSES COMP W/WO C	CT SINUSES COMP W/WO C	Radiology	70488	CPT	2201032		Washington Regional Medical Center	outpatient	1737	868.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	610.73	282.5	1302.75
CT SINUSES COMP W/WO C	CT SINUSES COMP W/WO C	Radiology	70488	CPT	2201032		Washington Regional Medical Center	outpatient	1737	868.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	610.73	282.5	1302.75
CT SINUSES COMP W/WO C	CT SINUSES COMP W/WO C	Radiology	70488	CPT	2201032		Washington Regional Medical Center	outpatient	1737	868.5	Cigna	North Carolina PPO-PPA Direct	282.5	282.5	1302.75
CT SINUSES COMP W/WO C	CT SINUSES COMP W/WO C	Radiology	70488	CPT	2201032		Washington Regional Medical Center	outpatient	1737	868.5	Original Medicare	Traditional Medicare Fee-for-Service	816.39	282.5	1302.75
CT SPINE CERV WO/C	CT SPINE CERV WO/C	Radiology	72125	CPT	2201035		Washington Regional Medical Center	outpatient	2462	1231	Self-Pay	Discounted Cash		236.16	1846.5
CT SPINE CERV WO/C	CT SPINE CERV WO/C	Radiology	72125	CPT	2201035		Washington Regional Medical Center	outpatient	2462	1231	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1846.5	236.16	1846.5
CT SPINE CERV WO/C	CT SPINE CERV WO/C	Radiology	72125	CPT	2201035		Washington Regional Medical Center	outpatient	2462	1231	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	1083.28	236.16	1846.5
CT SPINE CERV WO/C	CT SPINE CERV WO/C	Radiology	72125	CPT	2201035		Washington Regional Medical Center	outpatient	2462	1231	Humana	Medicare Advantage HMO/PPO/PFFS	1157.14	236.16	1846.5
CT SPINE CERV WO/C	CT SPINE CERV WO/C	Radiology	72125	CPT	2201035		Washington Regional Medical Center	outpatient	2462	1231	AmeriHealth Caritas North Carolina	NC Medicaid	865.64	236.16	1846.5
CT SPINE CERV WO/C	CT SPINE CERV WO/C	Radiology	72125	CPT	2201035		Washington Regional Medical Center	outpatient	2462	1231	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	865.64	236.16	1846.5
CT SPINE CERV WO/C	CT SPINE CERV WO/C	Radiology	72125	CPT	2201035		Washington Regional Medical Center	outpatient	2462	1231	WellCare of North Carolina	North Carolina Medicaid/CHIP	865.64	236.16	1846.5
CT SPINE CERV WO/C	CT SPINE CERV WO/C	Radiology	72125	CPT	2201035		Washington Regional Medical Center	outpatient	2462	1231	Healthy Blue / Blue Cross NC	North Carolina Medicaid	865.64	236.16	1846.5
CT SPINE CERV WO/C	CT SPINE CERV WO/C	Radiology	72125	CPT	2201035		Washington Regional Medical Center	outpatient	2462	1231	Cigna	North Carolina PPO-PPA Direct	236.16	236.16	1846.5
CT SPINE CERV WO/C	CT SPINE CERV WO/C	Radiology	72125	CPT	2201035		Washington Regional Medical Center	outpatient	2462	1231	Original Medicare	Traditional Medicare Fee-for-Service	1157.14	236.16	1846.5
CT SPINE LUMBAR W/C	CT SPINE LUMBAR W/C	Radiology	72132	CPT	2201036		Washington Regional Medical Center	outpatient	1989	994.5	Self-Pay	Discounted Cash		282.5	1491.75
CT SPINE LUMBAR W/C	CT SPINE LUMBAR W/C	Radiology	72132	CPT	2201036		Washington Regional Medical Center	outpatient	1989	994.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1491.75	282.5	1491.75
CT SPINE LUMBAR W/C	CT SPINE LUMBAR W/C	Radiology	72132	CPT	2201036		Washington Regional Medical Center	outpatient	1989	994.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	875.16	282.5	1491.75
CT SPINE LUMBAR W/C	CT SPINE LUMBAR W/C	Radiology	72132	CPT	2201036		Washington Regional Medical Center	outpatient	1989	994.5	Humana	Medicare Advantage HMO/PPO/PFFS	934.83	282.5	1491.75
CT SPINE LUMBAR W/C	CT SPINE LUMBAR W/C	Radiology	72132	CPT	2201036		Washington Regional Medical Center	outpatient	1989	994.5	AmeriHealth Caritas North Carolina	NC Medicaid	699.33	282.5	1491.75
CT SPINE LUMBAR W/C	CT SPINE LUMBAR W/C	Radiology	72132	CPT	2201036		Washington Regional Medical Center	outpatient	1989	994.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	699.33	282.5	1491.75
CT SPINE LUMBAR W/C	CT SPINE LUMBAR W/C	Radiology	72132	CPT	2201036		Washington Regional Medical Center	outpatient	1989	994.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	699.33	282.5	1491.75
CT SPINE LUMBAR W/C	CT SPINE LUMBAR W/C	Radiology	72132	CPT	2201036		Washington Regional Medical Center	outpatient	1989	994.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	699.33	282.5	1491.75
CT SPINE LUMBAR W/C	CT SPINE LUMBAR W/C	Radiology	72132	CPT	2201036		Washington Regional Medical Center	outpatient	1989	994.5	Cigna	North Carolina PPO-PPA Direct	282.5	282.5	1491.75
CT SPINE LUMBAR W/C	CT SPINE LUMBAR W/C	Radiology	72132	CPT	2201036		Washington Regional Medical Center	outpatient	1989	994.5	Original Medicare	Traditional Medicare Fee-for-Service	934.83	282.5	1491.75
CT THORAX W/C	CT THORAX W/C	Radiology	71260	CPT	2201006		Washington Regional Medical Center	outpatient	2586	1293	Self-Pay	Discounted Cash		282.5	1939.5
CT THORAX W/C	CT THORAX W/C	Radiology	71260	CPT	2201006		Washington Regional Medical Center	outpatient	2586	1293	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1939.5	282.5	1939.5
CT THORAX W/C	CT THORAX W/C	Radiology	71260	CPT	2201006		Washington Regional Medical Center	outpatient	2586	1293	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	1137.84	282.5	1939.5
CT THORAX W/C	CT THORAX W/C	Radiology	71260	CPT	2201006		Washington Regional Medical Center	outpatient	2586	1293	Humana	Medicare Advantage HMO/PPO/PFFS	1215.42	282.5	1939.5
CT THORAX W/C	CT THORAX W/C	Radiology	71260	CPT	2201006		Washington Regional Medical Center	outpatient	2586	1293	AmeriHealth Caritas North Carolina	NC Medicaid	909.24	282.5	1939.5
CT THORAX W/C	CT THORAX W/C	Radiology	71260	CPT	2201006		Washington Regional Medical Center	outpatient	2586	1293	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	909.24	282.5	1939.5
CT THORAX W/C	CT THORAX W/C	Radiology	71260	CPT	2201006		Washington Regional Medical Center	outpatient	2586	1293	WellCare of North Carolina	North Carolina Medicaid/CHIP	909.24	282.5	1939.5
CT THORAX W/C	CT THORAX W/C	Radiology	71260	CPT	2201006		Washington Regional Medical Center	outpatient	2586	1293	Healthy Blue / Blue Cross NC	North Carolina Medicaid	909.24	282.5	1939.5
CT THORAX W/C	CT THORAX W/C	Radiology	71260	CPT	2201006		Washington Regional Medical Center	outpatient	2586	1293	Cigna	North Carolina PPO-PPA Direct	282.5	282.5	1939.5
CT THORAX W/C	CT THORAX W/C	Radiology	71260	CPT	2201006		Washington Regional Medical Center	outpatient	2586	1293	Original Medicare	Traditional Medicare Fee-for-Service	1215.42	282.5	1939.5
CT UPPER EXT RT WO/C	CT UPPER EXT RT WO/C	Radiology	73200	CPT	2201038		Washington Regional Medical Center	outpatient	1381	690.5	Self-Pay	Discounted Cash		197.93	1035.75
CT UPPER EXT RT WO/C	CT UPPER EXT RT WO/C	Radiology	73200	CPT	2201038		Washington Regional Medical Center	outpatient	1381	690.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1035.75	197.93	1035.75
CT UPPER EXT RT WO/C	CT UPPER EXT RT WO/C	Radiology	73200	CPT	2201038		Washington Regional Medical Center	outpatient	1381	690.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	607.64	197.93	1035.75
CT UPPER EXT RT WO/C	CT UPPER EXT RT WO/C	Radiology	73200	CPT	2201038		Washington Regional Medical Center	outpatient	1381	690.5	Humana	Medicare Advantage HMO/PPO/PFFS	649.07	197.93	1035.75
CT UPPER EXT RT WO/C	CT UPPER EXT RT WO/C	Radiology	73200	CPT	2201038		Washington Regional Medical Center	outpatient	1381	690.5	AmeriHealth Caritas North Carolina	NC Medicaid	485.56	197.93	1035.75
CT UPPER EXT RT WO/C	CT UPPER EXT RT WO/C	Radiology	73200	CPT	2201038		Washington Regional Medical Center	outpatient	1381	690.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	485.56	197.93	1035.75
CT UPPER EXT RT WO/C	CT UPPER EXT RT WO/C	Radiology	73200	CPT	2201038		Washington Regional Medical Center	outpatient	1381	690.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	485.56	197.93	1035.75
CT UPPER EXT RT WO/C	CT UPPER EXT RT WO/C	Radiology	73200	CPT	2201038		Washington Regional Medical Center	outpatient	1381	690.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	485.56	197.93	1035.75
CT UPPER EXT RT WO/C	CT UPPER EXT RT WO/C	Radiology	73200	CPT	2201038		Washington Regional Medical Center	outpatient	1381	690.5	Cigna	North Carolina PPO-PPA Direct	197.93	197.93	1035.75
CT UPPER EXT RT WO/C	CT UPPER EXT RT WO/C	Radiology	73200	CPT	2201038		Washington Regional Medical Center	outpatient	1381	690.5	Original Medicare	Traditional Medicare Fee-for-Service	649.07	197.93	1035.75
CT UPPER EXTLT WO/C	CT UPPER EXTLT WO/C	Radiology	73200	CPT	2201039		Washington Regional Medical Center	outpatient	1381	690.5	Self-Pay	Discounted Cash		197.93	1035.75
CT UPPER EXTLT WO/C	CT UPPER EXTLT WO/C	Radiology	73200	CPT	2201039		Washington Regional Medical Center	outpatient	1381	690.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1035.75	197.93	1035.75
CT UPPER EXTLT WO/C	CT UPPER EXTLT WO/C	Radiology	73200	CPT	2201039		Washington Regional Medical Center	outpatient	1381	690.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	607.64	197.93	1035.75
CT UPPER EXTLT WO/C	CT UPPER EXTLT WO/C	Radiology	73200	CPT	2201039		Washington Regional Medical Center	outpatient	1381	690.5	Humana	Medicare Advantage HMO/PPO/PFFS	649.07	197.93	1035.75
CT UPPER EXTLT WO/C	CT UPPER EXTLT WO/C	Radiology	73200	CPT	2201039		Washington Regional Medical Center	outpatient	1381	690.5	AmeriHealth Caritas North Carolina	NC Medicaid	485.56	197.93	1035.75
CT UPPER EXTLT WO/C	CT UPPER EXTLT WO/C	Radiology	73200	CPT	2201039		Washington Regional Medical Center	outpatient	1381	690.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	485.56	197.93	1035.75
CT UPPER EXTLT WO/C	CT UPPER EXTLT WO/C	Radiology	73200	CPT	2201039		Washington Regional Medical Center	outpatient	1381	690.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	485.56	197.93	1035.75
CT UPPER EXTLT WO/C	CT UPPER EXTLT WO/C	Radiology	73200	CPT	2201039		Washington Regional Medical Center	outpatient	1381	690.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	485.56	197.93	1035.75
CT UPPER EXTLT WO/C	CT UPPER EXTLT WO/C	Radiology	73200	CPT	2201039		Washington Regional Medical Center	outpatient	1381	690.5	Cigna	North Carolina PPO-PPA Direct	197.93	197.93	1035.75
CT UPPER EXTLT WO/C	CT UPPER EXTLT WO/C	Radiology	73200	CPT	2201039		Washington Regional Medical Center	outpatient	1381	690.5	Original Medicare	Traditional Medicare Fee-for-Service	649.07	197.93	1035.75
CT WRIST LT WO CON	CT WRIST LT WO CON	Radiology	73200	CPT	2201167		Washington Regional Medical Center	outpatient	1381	690.5	Self-Pay	Discounted Cash		197.93	1035.75
CT WRIST LT WO CON	CT WRIST LT WO CON	Radiology	73200	CPT	2201167		Washington Regional Medical Center	outpatient	1381	690.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1035.75	197.93	1035.75
CT WRIST LT WO CON	CT WRIST LT WO CON	Radiology	73200	CPT	2201167		Washington Regional Medical Center	outpatient	1381	690.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	607.64	197.93	1035.75
CT WRIST LT WO CON	CT WRIST LT WO CON	Radiology	73200	CPT	2201167		Washington Regional Medical Center	outpatient	1381	690.5	Humana	Medicare Advantage HMO/PPO/PFFS	649.07	197.93	1035.75
CT WRIST LT WO CON	CT WRIST LT WO CON	Radiology	73200	CPT	2201167		Washington Regional Medical Center	outpatient	1381	690.5	AmeriHealth Caritas North Carolina	NC Medicaid	485.56	197.93	1035.75
CT WRIST LT WO CON	CT WRIST LT WO CON	Radiology	73200	CPT	2201167		Washington Regional Medical Center	outpatient	1381	690.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	485.56	197.93	1035.75
CT WRIST LT WO CON	CT WRIST LT WO CON	Radiology	73200	CPT	2201167		Washington Regional Medical Center	outpatient	1381	690.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	485.56	197.93	1035.75
CT WRIST LT WO CON	CT WRIST LT WO CON	Radiology	73200	CPT	2201167		Washington Regional Medical Center	outpatient	1381	690.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	485.56	197.93	1035.75
CT WRIST LT WO CON	CT WRIST LT WO CON	Radiology	73200	CPT	2201167		Washington Regional Medical Center	outpatient	1381	690.5	Cigna	North Carolina PPO-PPA Direct	197.93	197.93	1035.75
CT WRIST LT WO CON	CT WRIST LT WO CON	Radiology	73200	CPT	2201167		Washington Regional Medical Center	outpatient	1381	690.5	Original Medicare	Traditional Medicare Fee-for-Service	649.07	197.93	1035.75
CT WRIST RT WO CON	CT WRIST RT WO CON	Radiology	73200	CPT	2201170		Washington Regional Medical Center	outpatient	1381	690.5	Self-Pay	Discounted Cash		197.93	1035.75
CT WRIST RT WO CON	CT WRIST RT WO CON	Radiology	73200	CPT	2201170		Washington Regional Medical Center	outpatient	1381	690.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1035.75	197.93	1035.75
CT WRIST RT WO CON	CT WRIST RT WO CON	Radiology	73200	CPT	2201170		Washington Regional Medical Center	outpatient	1381	690.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	607.64	197.93	1035.75
CT WRIST RT WO CON	CT WRIST RT WO CON	Radiology	73200	CPT	2201170		Washington Regional Medical Center	outpatient	1381	690.5	Humana	Medicare Advantage HMO/PPO/PFFS	649.07	197.93	1035.75
CT WRIST RT WO CON	CT WRIST RT WO CON	Radiology	73200	CPT	2201170		Washington Regional Medical Center	outpatient	1381	690.5	AmeriHealth Caritas North Carolina	NC Medicaid	485.56	197.93	1035.75
CT WRIST RT WO CON	CT WRIST RT WO CON	Radiology	73200	CPT	2201170		Washington Regional Medical Center	outpatient	1381	690.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	485.56	197.93	1035.75
CT WRIST RT WO CON	CT WRIST RT WO CON	Radiology	73200	CPT	2201170		Washington Regional Medical Center	outpatient	1381	690.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	485.56	197.93	1035.75
CT WRIST RT WO CON	CT WRIST RT WO CON	Radiology	73200	CPT	2201170		Washington Regional Medical Center	outpatient	1381	690.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	485.56	197.93	1035.75
CT WRIST RT WO CON	CT WRIST RT WO CON	Radiology	73200	CPT	2201170		Washington Regional Medical Center	outpatient	1381	690.5	Cigna	North Carolina PPO-PPA Direct	197.93	197.93	1035.75
CT WRIST RT WO CON	CT WRIST RT WO CON	Radiology	73200	CPT	2201170		Washington Regional Medical Center	outpatient	1381	690.5	Original Medicare	Traditional Medicare Fee-for-Service	649.07	197.93	1035.75
CTA ABD W/C	CTA ABD W/C	Radiology	74175	CPT	2201046		Washington Regional Medical Center	outpatient	2919	1459.5	Self-Pay	Discounted Cash		474.29	2189.25
CTA ABD W/C	CTA ABD W/C	Radiology	74175	CPT	2201046		Washington Regional Medical Center	outpatient	2919	1459.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	2189.25	474.29	2189.25
CTA ABD W/C	CTA ABD W/C	Radiology	74175	CPT	2201046		Washington Regional Medical Center	outpatient	2919	1459.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	1284.36	474.29	2189.25
CTA ABD W/C	CTA ABD W/C	Radiology	74175	CPT	2201046		Washington Regional Medical Center	outpatient	2919	1459.5	Humana	Medicare Advantage HMO/PPO/PFFS	1371.93	474.29	2189.25
CTA ABD W/C	CTA ABD W/C	Radiology	74175	CPT	2201046		Washington Regional Medical Center	outpatient	2919	1459.5	AmeriHealth Caritas North Carolina	NC Medicaid	1026.32	474.29	2189.25
CTA ABD W/C	CTA ABD W/C	Radiology	74175	CPT	2201046		Washington Regional Medical Center	outpatient	2919	1459.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	1026.32	474.29	2189.25
CTA ABD W/C	CTA ABD W/C	Radiology	74175	CPT	2201046		Washington Regional Medical Center	outpatient	2919	1459.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	1026.32	474.29	2189.25
CTA ABD W/C	CTA ABD W/C	Radiology	74175	CPT	2201046		Washington Regional Medical Center	outpatient	2919	1459.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	1026.32	474.29	2189.25
CTA ABD W/C	CTA ABD W/C	Radiology	74175	CPT	2201046		Washington Regional Medical Center	outpatient	2919	1459.5	Cigna	North Carolina PPO-PPA Direct	474.29	474.29	2189.25
CTA ABD W/C	CTA ABD W/C	Radiology	74175	CPT	2201046		Washington Regional Medical Center	outpatient	2919	1459.5	Original Medicare	Traditional Medicare Fee-for-Service	1371.93	474.29	2189.25
CTA PELVIS W/C	CTA PELVIS W/C	Radiology	72191	CPT	2201086		Washington Regional Medical Center	outpatient	2919	1459.5	Self-Pay	Discounted Cash		474.29	2189.25
CTA PELVIS W/C	CTA PELVIS W/C	Radiology	72191	CPT	2201086		Washington Regional Medical Center	outpatient	2919	1459.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	2189.25	474.29	2189.25
CTA PELVIS W/C	CTA PELVIS W/C	Radiology	72191	CPT	2201086		Washington Regional Medical Center	outpatient	2919	1459.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	1284.36	474.29	2189.25
CTA PELVIS W/C	CTA PELVIS W/C	Radiology	72191	CPT	2201086		Washington Regional Medical Center	outpatient	2919	1459.5	Humana	Medicare Advantage HMO/PPO/PFFS	1371.93	474.29	2189.25
CTA PELVIS W/C	CTA PELVIS W/C	Radiology	72191	CPT	2201086		Washington Regional Medical Center	outpatient	2919	1459.5	AmeriHealth Caritas North Carolina	NC Medicaid	1026.32	474.29	2189.25
CTA PELVIS W/C	CTA PELVIS W/C	Radiology	72191	CPT	2201086		Washington Regional Medical Center	outpatient	2919	1459.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	1026.32	474.29	2189.25
CTA PELVIS W/C	CTA PELVIS W/C	Radiology	72191	CPT	2201086		Washington Regional Medical Center	outpatient	2919	1459.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	1026.32	474.29	2189.25
CTA PELVIS W/C	CTA PELVIS W/C	Radiology	72191	CPT	2201086		Washington Regional Medical Center	outpatient	2919	1459.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	1026.32	474.29	2189.25
CTA PELVIS W/C	CTA PELVIS W/C	Radiology	72191	CPT	2201086		Washington Regional Medical Center	outpatient	2919	1459.5	Cigna	North Carolina PPO-PPA Direct	474.29	474.29	2189.25
CTA PELVIS W/C	CTA PELVIS W/C	Radiology	72191	CPT	2201086		Washington Regional Medical Center	outpatient	2919	1459.5	Original Medicare	Traditional Medicare Fee-for-Service	1371.93	474.29	2189.25
DEXA BONE DENSITY AXIAL	DEXA BONE DENSITY AXIAL	Radiology	77080	CPT	2001243		Washington Regional Medical Center	outpatient	275	137.5	Self-Pay	Discounted Cash		96.69	206.25
DEXA BONE DENSITY AXIAL	DEXA BONE DENSITY AXIAL	Radiology	77080	CPT	2001243		Washington Regional Medical Center	outpatient	275	137.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	206.25	96.69	206.25
DEXA BONE DENSITY AXIAL	DEXA BONE DENSITY AXIAL	Radiology	77080	CPT	2001243		Washington Regional Medical Center	outpatient	275	137.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	121	96.69	206.25
DEXA BONE DENSITY AXIAL	DEXA BONE DENSITY AXIAL	Radiology	77080	CPT	2001243		Washington Regional Medical Center	outpatient	275	137.5	Humana	Medicare Advantage HMO/PPO/PFFS	129.25	96.69	206.25
DEXA BONE DENSITY AXIAL	DEXA BONE DENSITY AXIAL	Radiology	77080	CPT	2001243		Washington Regional Medical Center	outpatient	275	137.5	AmeriHealth Caritas North Carolina	NC Medicaid	96.69	96.69	206.25
DEXA BONE DENSITY AXIAL	DEXA BONE DENSITY AXIAL	Radiology	77080	CPT	2001243		Washington Regional Medical Center	outpatient	275	137.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	96.69	96.69	206.25
DEXA BONE DENSITY AXIAL	DEXA BONE DENSITY AXIAL	Radiology	77080	CPT	2001243		Washington Regional Medical Center	outpatient	275	137.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	96.69	96.69	206.25
DEXA BONE DENSITY AXIAL	DEXA BONE DENSITY AXIAL	Radiology	77080	CPT	2001243		Washington Regional Medical Center	outpatient	275	137.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	96.69	96.69	206.25
DEXA BONE DENSITY AXIAL	DEXA BONE DENSITY AXIAL	Radiology	77080	CPT	2001243		Washington Regional Medical Center	outpatient	275	137.5	Cigna	North Carolina PPO-PPA Direct	100.94	96.69	206.25
DEXA BONE DENSITY AXIAL	DEXA BONE DENSITY AXIAL	Radiology	77080	CPT	2001243		Washington Regional Medical Center	outpatient	275	137.5	Original Medicare	Traditional Medicare Fee-for-Service	129.25	96.69	206.25
ESOPHAGUS	ESOPHAGUS	Radiology	74220	CPT	2001163		Washington Regional Medical Center	outpatient	620	310	Self-Pay	Discounted Cash		47.49	465
ESOPHAGUS	ESOPHAGUS	Radiology	74220	CPT	2001163		Washington Regional Medical Center	outpatient	620	310	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	465	47.49	465
ESOPHAGUS	ESOPHAGUS	Radiology	74220	CPT	2001163		Washington Regional Medical Center	outpatient	620	310	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	272.8	47.49	465
ESOPHAGUS	ESOPHAGUS	Radiology	74220	CPT	2001163		Washington Regional Medical Center	outpatient	620	310	Humana	Medicare Advantage HMO/PPO/PFFS	291.4	47.49	465
ESOPHAGUS	ESOPHAGUS	Radiology	74220	CPT	2001163		Washington Regional Medical Center	outpatient	620	310	AmeriHealth Caritas North Carolina	NC Medicaid	217.99	47.49	465
ESOPHAGUS	ESOPHAGUS	Radiology	74220	CPT	2001163		Washington Regional Medical Center	outpatient	620	310	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	217.99	47.49	465
ESOPHAGUS	ESOPHAGUS	Radiology	74220	CPT	2001163		Washington Regional Medical Center	outpatient	620	310	WellCare of North Carolina	North Carolina Medicaid/CHIP	217.99	47.49	465
ESOPHAGUS	ESOPHAGUS	Radiology	74220	CPT	2001163		Washington Regional Medical Center	outpatient	620	310	Healthy Blue / Blue Cross NC	North Carolina Medicaid	217.99	47.49	465
ESOPHAGUS	ESOPHAGUS	Radiology	74220	CPT	2001163		Washington Regional Medical Center	outpatient	620	310	Cigna	North Carolina PPO-PPA Direct	47.49	47.49	465
ESOPHAGUS	ESOPHAGUS	Radiology	74220	CPT	2001163		Washington Regional Medical Center	outpatient	620	310	Original Medicare	Traditional Medicare Fee-for-Service	291.4	47.49	465
FEMUR MIN 2 VIEWS LT	FEMUR MIN 2 VIEWS LT	Radiology	73552	CPT	2000043		Washington Regional Medical Center	outpatient	242	121	Self-Pay	Discounted Cash		20.32	181.5
FEMUR MIN 2 VIEWS LT	FEMUR MIN 2 VIEWS LT	Radiology	73552	CPT	2000043		Washington Regional Medical Center	outpatient	242	121	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	181.5	20.32	181.5
FEMUR MIN 2 VIEWS LT	FEMUR MIN 2 VIEWS LT	Radiology	73552	CPT	2000043		Washington Regional Medical Center	outpatient	242	121	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	106.48	20.32	181.5
FEMUR MIN 2 VIEWS LT	FEMUR MIN 2 VIEWS LT	Radiology	73552	CPT	2000043		Washington Regional Medical Center	outpatient	242	121	Humana	Medicare Advantage HMO/PPO/PFFS	113.74	20.32	181.5
FEMUR MIN 2 VIEWS LT	FEMUR MIN 2 VIEWS LT	Radiology	73552	CPT	2000043		Washington Regional Medical Center	outpatient	242	121	AmeriHealth Caritas North Carolina	NC Medicaid	85.09	20.32	181.5
FEMUR MIN 2 VIEWS LT	FEMUR MIN 2 VIEWS LT	Radiology	73552	CPT	2000043		Washington Regional Medical Center	outpatient	242	121	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	20.32	20.32	181.5
FEMUR MIN 2 VIEWS LT	FEMUR MIN 2 VIEWS LT	Radiology	73552	CPT	2000043		Washington Regional Medical Center	outpatient	242	121	WellCare of North Carolina	North Carolina Medicaid/CHIP	85.09	20.32	181.5
FEMUR MIN 2 VIEWS LT	FEMUR MIN 2 VIEWS LT	Radiology	73552	CPT	2000043		Washington Regional Medical Center	outpatient	242	121	Healthy Blue / Blue Cross NC	North Carolina Medicaid	85.09	20.32	181.5
FEMUR MIN 2 VIEWS LT	FEMUR MIN 2 VIEWS LT	Radiology	73552	CPT	2000043		Washington Regional Medical Center	outpatient	242	121	Cigna	North Carolina PPO-PPA Direct	24.56	20.32	181.5
FEMUR MIN 2 VIEWS LT	FEMUR MIN 2 VIEWS LT	Radiology	73552	CPT	2000043		Washington Regional Medical Center	outpatient	242	121	Original Medicare	Traditional Medicare Fee-for-Service	113.74	20.32	181.5
FEMUR MIN 2 VIEWS RT	FEMUR MIN 2 VIEWS RT	Radiology	73552	CPT	2000046		Washington Regional Medical Center	outpatient	242	121	Self-Pay	Discounted Cash		20.32	181.5
FEMUR MIN 2 VIEWS RT	FEMUR MIN 2 VIEWS RT	Radiology	73552	CPT	2000046		Washington Regional Medical Center	outpatient	242	121	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	181.5	20.32	181.5
FEMUR MIN 2 VIEWS RT	FEMUR MIN 2 VIEWS RT	Radiology	73552	CPT	2000046		Washington Regional Medical Center	outpatient	242	121	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	106.48	20.32	181.5
FEMUR MIN 2 VIEWS RT	FEMUR MIN 2 VIEWS RT	Radiology	73552	CPT	2000046		Washington Regional Medical Center	outpatient	242	121	Humana	Medicare Advantage HMO/PPO/PFFS	113.74	20.32	181.5
FEMUR MIN 2 VIEWS RT	FEMUR MIN 2 VIEWS RT	Radiology	73552	CPT	2000046		Washington Regional Medical Center	outpatient	242	121	AmeriHealth Caritas North Carolina	NC Medicaid	85.09	20.32	181.5
FEMUR MIN 2 VIEWS RT	FEMUR MIN 2 VIEWS RT	Radiology	73552	CPT	2000046		Washington Regional Medical Center	outpatient	242	121	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	20.32	20.32	181.5
FEMUR MIN 2 VIEWS RT	FEMUR MIN 2 VIEWS RT	Radiology	73552	CPT	2000046		Washington Regional Medical Center	outpatient	242	121	WellCare of North Carolina	North Carolina Medicaid/CHIP	85.09	20.32	181.5
FEMUR MIN 2 VIEWS RT	FEMUR MIN 2 VIEWS RT	Radiology	73552	CPT	2000046		Washington Regional Medical Center	outpatient	242	121	Healthy Blue / Blue Cross NC	North Carolina Medicaid	85.09	20.32	181.5
FEMUR MIN 2 VIEWS RT	FEMUR MIN 2 VIEWS RT	Radiology	73552	CPT	2000046		Washington Regional Medical Center	outpatient	242	121	Cigna	North Carolina PPO-PPA Direct	24.56	20.32	181.5
FEMUR MIN 2 VIEWS RT	FEMUR MIN 2 VIEWS RT	Radiology	73552	CPT	2000046		Washington Regional Medical Center	outpatient	242	121	Original Medicare	Traditional Medicare Fee-for-Service	113.74	20.32	181.5
Fetal Echocardiography 76825	Fetal Echocardiography 76825	Radiology	76825	CPT	4631222		Washington Regional Medical Center	outpatient	1800	900	Self-Pay	Discounted Cash		78.9	1350
Fetal Echocardiography 76825	Fetal Echocardiography 76825	Radiology	76825	CPT	4631222		Washington Regional Medical Center	outpatient	1800	900	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1350	78.9	1350
Fetal Echocardiography 76825	Fetal Echocardiography 76825	Radiology	76825	CPT	4631222		Washington Regional Medical Center	outpatient	1800	900	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	792	78.9	1350
Fetal Echocardiography 76825	Fetal Echocardiography 76825	Radiology	76825	CPT	4631222		Washington Regional Medical Center	outpatient	1800	900	Humana	Medicare Advantage HMO/PPO/PFFS	846	78.9	1350
Fetal Echocardiography 76825	Fetal Echocardiography 76825	Radiology	76825	CPT	4631222		Washington Regional Medical Center	outpatient	1800	900	AmeriHealth Caritas North Carolina	NC Medicaid	632.88	78.9	1350
Fetal Echocardiography 76825	Fetal Echocardiography 76825	Radiology	76825	CPT	4631222		Washington Regional Medical Center	outpatient	1800	900	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	632.88	78.9	1350
Fetal Echocardiography 76825	Fetal Echocardiography 76825	Radiology	76825	CPT	4631222		Washington Regional Medical Center	outpatient	1800	900	WellCare of North Carolina	North Carolina Medicaid/CHIP	632.88	78.9	1350
Fetal Echocardiography 76825	Fetal Echocardiography 76825	Radiology	76825	CPT	4631222		Washington Regional Medical Center	outpatient	1800	900	Healthy Blue / Blue Cross NC	North Carolina Medicaid	632.88	78.9	1350
Fetal Echocardiography 76825	Fetal Echocardiography 76825	Radiology	76825	CPT	4631222		Washington Regional Medical Center	outpatient	1800	900	Cigna	North Carolina PPO-PPA Direct	78.9	78.9	1350
Fetal Echocardiography 76825	Fetal Echocardiography 76825	Radiology	76825	CPT	4631222		Washington Regional Medical Center	outpatient	1800	900	Original Medicare	Traditional Medicare Fee-for-Service	846	78.9	1350
FLUORO IVC PLACEMENT	FLUORO IVC PLACEMENT	Radiology	77001	CPT	2001200		Washington Regional Medical Center	outpatient	245	122.5	Self-Pay	Discounted Cash		64.37	183.75
FLUORO IVC PLACEMENT	FLUORO IVC PLACEMENT	Radiology	77001	CPT	2001200		Washington Regional Medical Center	outpatient	245	122.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	183.75	64.37	183.75
FLUORO IVC PLACEMENT	FLUORO IVC PLACEMENT	Radiology	77001	CPT	2001200		Washington Regional Medical Center	outpatient	245	122.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	107.8	64.37	183.75
FLUORO IVC PLACEMENT	FLUORO IVC PLACEMENT	Radiology	77001	CPT	2001200		Washington Regional Medical Center	outpatient	245	122.5	Humana	Medicare Advantage HMO/PPO/PFFS	115.15	64.37	183.75
FLUORO IVC PLACEMENT	FLUORO IVC PLACEMENT	Radiology	77001	CPT	2001200		Washington Regional Medical Center	outpatient	245	122.5	AmeriHealth Caritas North Carolina	NC Medicaid	86.14	64.37	183.75
FLUORO IVC PLACEMENT	FLUORO IVC PLACEMENT	Radiology	77001	CPT	2001200		Washington Regional Medical Center	outpatient	245	122.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	86.14	64.37	183.75
FLUORO IVC PLACEMENT	FLUORO IVC PLACEMENT	Radiology	77001	CPT	2001200		Washington Regional Medical Center	outpatient	245	122.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	86.14	64.37	183.75
FLUORO IVC PLACEMENT	FLUORO IVC PLACEMENT	Radiology	77001	CPT	2001200		Washington Regional Medical Center	outpatient	245	122.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	86.14	64.37	183.75
FLUORO IVC PLACEMENT	FLUORO IVC PLACEMENT	Radiology	77001	CPT	2001200		Washington Regional Medical Center	outpatient	245	122.5	Cigna	North Carolina PPO-PPA Direct	64.37	64.37	183.75
FLUORO IVC PLACEMENT	FLUORO IVC PLACEMENT	Radiology	77001	CPT	2001200		Washington Regional Medical Center	outpatient	245	122.5	Original Medicare	Traditional Medicare Fee-for-Service	115.15	64.37	183.75
FOOT, 3 VIEWS LT	FOOT, 3 VIEWS LT	Radiology	73630	CPT	2001019		Washington Regional Medical Center	outpatient	367	183.5	Self-Pay	Discounted Cash		20.97	275.25
FOOT, 3 VIEWS LT	FOOT, 3 VIEWS LT	Radiology	73630	CPT	2001019		Washington Regional Medical Center	outpatient	367	183.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	275.25	20.97	275.25
FOOT, 3 VIEWS LT	FOOT, 3 VIEWS LT	Radiology	73630	CPT	2001019		Washington Regional Medical Center	outpatient	367	183.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	161.48	20.97	275.25
FOOT, 3 VIEWS LT	FOOT, 3 VIEWS LT	Radiology	73630	CPT	2001019		Washington Regional Medical Center	outpatient	367	183.5	Humana	Medicare Advantage HMO/PPO/PFFS	172.49	20.97	275.25
FOOT, 3 VIEWS LT	FOOT, 3 VIEWS LT	Radiology	73630	CPT	2001019		Washington Regional Medical Center	outpatient	367	183.5	AmeriHealth Caritas North Carolina	NC Medicaid	129.04	20.97	275.25
FOOT, 3 VIEWS LT	FOOT, 3 VIEWS LT	Radiology	73630	CPT	2001019		Washington Regional Medical Center	outpatient	367	183.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	129.04	20.97	275.25
FOOT, 3 VIEWS LT	FOOT, 3 VIEWS LT	Radiology	73630	CPT	2001019		Washington Regional Medical Center	outpatient	367	183.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	129.04	20.97	275.25
FOOT, 3 VIEWS LT	FOOT, 3 VIEWS LT	Radiology	73630	CPT	2001019		Washington Regional Medical Center	outpatient	367	183.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	129.04	20.97	275.25
FOOT, 3 VIEWS LT	FOOT, 3 VIEWS LT	Radiology	73630	CPT	2001019		Washington Regional Medical Center	outpatient	367	183.5	Cigna	North Carolina PPO-PPA Direct	20.97	20.97	275.25
FOOT, 3 VIEWS LT	FOOT, 3 VIEWS LT	Radiology	73630	CPT	2001019		Washington Regional Medical Center	outpatient	367	183.5	Original Medicare	Traditional Medicare Fee-for-Service	172.49	20.97	275.25
FOOT, 3 VIEWS RT	FOOT, 3 VIEWS RT	Radiology	73630	CPT	2001116		Washington Regional Medical Center	outpatient	367	183.5	Self-Pay	Discounted Cash		20.97	275.25
FOOT, 3 VIEWS RT	FOOT, 3 VIEWS RT	Radiology	73630	CPT	2001116		Washington Regional Medical Center	outpatient	367	183.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	275.25	20.97	275.25
FOOT, 3 VIEWS RT	FOOT, 3 VIEWS RT	Radiology	73630	CPT	2001116		Washington Regional Medical Center	outpatient	367	183.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	161.48	20.97	275.25
FOOT, 3 VIEWS RT	FOOT, 3 VIEWS RT	Radiology	73630	CPT	2001116		Washington Regional Medical Center	outpatient	367	183.5	Humana	Medicare Advantage HMO/PPO/PFFS	172.49	20.97	275.25
FOOT, 3 VIEWS RT	FOOT, 3 VIEWS RT	Radiology	73630	CPT	2001116		Washington Regional Medical Center	outpatient	367	183.5	AmeriHealth Caritas North Carolina	NC Medicaid	129.04	20.97	275.25
FOOT, 3 VIEWS RT	FOOT, 3 VIEWS RT	Radiology	73630	CPT	2001116		Washington Regional Medical Center	outpatient	367	183.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	129.04	20.97	275.25
FOOT, 3 VIEWS RT	FOOT, 3 VIEWS RT	Radiology	73630	CPT	2001116		Washington Regional Medical Center	outpatient	367	183.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	129.04	20.97	275.25
FOOT, 3 VIEWS RT	FOOT, 3 VIEWS RT	Radiology	73630	CPT	2001116		Washington Regional Medical Center	outpatient	367	183.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	129.04	20.97	275.25
FOOT, 3 VIEWS RT	FOOT, 3 VIEWS RT	Radiology	73630	CPT	2001116		Washington Regional Medical Center	outpatient	367	183.5	Cigna	North Carolina PPO-PPA Direct	20.97	20.97	275.25
FOOT, 3 VIEWS RT	FOOT, 3 VIEWS RT	Radiology	73630	CPT	2001116		Washington Regional Medical Center	outpatient	367	183.5	Original Medicare	Traditional Medicare Fee-for-Service	172.49	20.97	275.25
HAND, 2 VIEWS LT	HAND, 2 VIEWS LT	Radiology	73120	CPT	2001172		Washington Regional Medical Center	outpatient	275	137.5	Self-Pay	Discounted Cash		19.43	206.25
HAND, 2 VIEWS LT	HAND, 2 VIEWS LT	Radiology	73120	CPT	2001172		Washington Regional Medical Center	outpatient	275	137.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	206.25	19.43	206.25
HAND, 2 VIEWS LT	HAND, 2 VIEWS LT	Radiology	73120	CPT	2001172		Washington Regional Medical Center	outpatient	275	137.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	121	19.43	206.25
HAND, 2 VIEWS LT	HAND, 2 VIEWS LT	Radiology	73120	CPT	2001172		Washington Regional Medical Center	outpatient	275	137.5	Humana	Medicare Advantage HMO/PPO/PFFS	129.25	19.43	206.25
HAND, 2 VIEWS LT	HAND, 2 VIEWS LT	Radiology	73120	CPT	2001172		Washington Regional Medical Center	outpatient	275	137.5	AmeriHealth Caritas North Carolina	NC Medicaid	96.69	19.43	206.25
HAND, 2 VIEWS LT	HAND, 2 VIEWS LT	Radiology	73120	CPT	2001172		Washington Regional Medical Center	outpatient	275	137.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	96.69	19.43	206.25
HAND, 2 VIEWS LT	HAND, 2 VIEWS LT	Radiology	73120	CPT	2001172		Washington Regional Medical Center	outpatient	275	137.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	96.69	19.43	206.25
HAND, 2 VIEWS LT	HAND, 2 VIEWS LT	Radiology	73120	CPT	2001172		Washington Regional Medical Center	outpatient	275	137.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	96.69	19.43	206.25
HAND, 2 VIEWS LT	HAND, 2 VIEWS LT	Radiology	73120	CPT	2001172		Washington Regional Medical Center	outpatient	275	137.5	Cigna	North Carolina PPO-PPA Direct	19.43	19.43	206.25
HAND, 2 VIEWS LT	HAND, 2 VIEWS LT	Radiology	73120	CPT	2001172		Washington Regional Medical Center	outpatient	275	137.5	Original Medicare	Traditional Medicare Fee-for-Service	129.25	19.43	206.25
HAND, 2 VIEWS RT	HAND, 2 VIEWS RT	Radiology	73120	CPT	2001183		Washington Regional Medical Center	outpatient	275	137.5	Self-Pay	Discounted Cash		19.43	206.25
HAND, 2 VIEWS RT	HAND, 2 VIEWS RT	Radiology	73120	CPT	2001183		Washington Regional Medical Center	outpatient	275	137.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	206.25	19.43	206.25
HAND, 2 VIEWS RT	HAND, 2 VIEWS RT	Radiology	73120	CPT	2001183		Washington Regional Medical Center	outpatient	275	137.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	121	19.43	206.25
HAND, 2 VIEWS RT	HAND, 2 VIEWS RT	Radiology	73120	CPT	2001183		Washington Regional Medical Center	outpatient	275	137.5	Humana	Medicare Advantage HMO/PPO/PFFS	129.25	19.43	206.25
HAND, 2 VIEWS RT	HAND, 2 VIEWS RT	Radiology	73120	CPT	2001183		Washington Regional Medical Center	outpatient	275	137.5	AmeriHealth Caritas North Carolina	NC Medicaid	96.69	19.43	206.25
HAND, 2 VIEWS RT	HAND, 2 VIEWS RT	Radiology	73120	CPT	2001183		Washington Regional Medical Center	outpatient	275	137.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	96.69	19.43	206.25
HAND, 2 VIEWS RT	HAND, 2 VIEWS RT	Radiology	73120	CPT	2001183		Washington Regional Medical Center	outpatient	275	137.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	96.69	19.43	206.25
HAND, 2 VIEWS RT	HAND, 2 VIEWS RT	Radiology	73120	CPT	2001183		Washington Regional Medical Center	outpatient	275	137.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	96.69	19.43	206.25
HAND, 2 VIEWS RT	HAND, 2 VIEWS RT	Radiology	73120	CPT	2001183		Washington Regional Medical Center	outpatient	275	137.5	Cigna	North Carolina PPO-PPA Direct	19.43	19.43	206.25
HAND, 2 VIEWS RT	HAND, 2 VIEWS RT	Radiology	73120	CPT	2001183		Washington Regional Medical Center	outpatient	275	137.5	Original Medicare	Traditional Medicare Fee-for-Service	129.25	19.43	206.25
HUMERUS, MIN 2V LT	HUMERUS, MIN 2V LT	Radiology	73060	CPT	2001008		Washington Regional Medical Center	outpatient	281	140.5	Self-Pay	Discounted Cash		23.05	210.75
HUMERUS, MIN 2V LT	HUMERUS, MIN 2V LT	Radiology	73060	CPT	2001008		Washington Regional Medical Center	outpatient	281	140.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	210.75	23.05	210.75
HUMERUS, MIN 2V LT	HUMERUS, MIN 2V LT	Radiology	73060	CPT	2001008		Washington Regional Medical Center	outpatient	281	140.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	123.64	23.05	210.75
HUMERUS, MIN 2V LT	HUMERUS, MIN 2V LT	Radiology	73060	CPT	2001008		Washington Regional Medical Center	outpatient	281	140.5	Humana	Medicare Advantage HMO/PPO/PFFS	132.07	23.05	210.75
HUMERUS, MIN 2V LT	HUMERUS, MIN 2V LT	Radiology	73060	CPT	2001008		Washington Regional Medical Center	outpatient	281	140.5	AmeriHealth Caritas North Carolina	NC Medicaid	98.8	23.05	210.75
HUMERUS, MIN 2V LT	HUMERUS, MIN 2V LT	Radiology	73060	CPT	2001008		Washington Regional Medical Center	outpatient	281	140.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	98.8	23.05	210.75
HUMERUS, MIN 2V LT	HUMERUS, MIN 2V LT	Radiology	73060	CPT	2001008		Washington Regional Medical Center	outpatient	281	140.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	98.8	23.05	210.75
HUMERUS, MIN 2V LT	HUMERUS, MIN 2V LT	Radiology	73060	CPT	2001008		Washington Regional Medical Center	outpatient	281	140.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	98.8	23.05	210.75
HUMERUS, MIN 2V LT	HUMERUS, MIN 2V LT	Radiology	73060	CPT	2001008		Washington Regional Medical Center	outpatient	281	140.5	Cigna	North Carolina PPO-PPA Direct	23.05	23.05	210.75
HUMERUS, MIN 2V LT	HUMERUS, MIN 2V LT	Radiology	73060	CPT	2001008		Washington Regional Medical Center	outpatient	281	140.5	Original Medicare	Traditional Medicare Fee-for-Service	132.07	23.05	210.75
HUMERUS, MIN 2V RT	HUMERUS, MIN 2V RT	Radiology	73060	CPT	2001122		Washington Regional Medical Center	outpatient	281	140.5	Self-Pay	Discounted Cash		23.05	210.75
HUMERUS, MIN 2V RT	HUMERUS, MIN 2V RT	Radiology	73060	CPT	2001122		Washington Regional Medical Center	outpatient	281	140.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	210.75	23.05	210.75
HUMERUS, MIN 2V RT	HUMERUS, MIN 2V RT	Radiology	73060	CPT	2001122		Washington Regional Medical Center	outpatient	281	140.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	123.64	23.05	210.75
HUMERUS, MIN 2V RT	HUMERUS, MIN 2V RT	Radiology	73060	CPT	2001122		Washington Regional Medical Center	outpatient	281	140.5	Humana	Medicare Advantage HMO/PPO/PFFS	132.07	23.05	210.75
HUMERUS, MIN 2V RT	HUMERUS, MIN 2V RT	Radiology	73060	CPT	2001122		Washington Regional Medical Center	outpatient	281	140.5	AmeriHealth Caritas North Carolina	NC Medicaid	98.8	23.05	210.75
HUMERUS, MIN 2V RT	HUMERUS, MIN 2V RT	Radiology	73060	CPT	2001122		Washington Regional Medical Center	outpatient	281	140.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	98.8	23.05	210.75
HUMERUS, MIN 2V RT	HUMERUS, MIN 2V RT	Radiology	73060	CPT	2001122		Washington Regional Medical Center	outpatient	281	140.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	98.8	23.05	210.75
HUMERUS, MIN 2V RT	HUMERUS, MIN 2V RT	Radiology	73060	CPT	2001122		Washington Regional Medical Center	outpatient	281	140.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	98.8	23.05	210.75
HUMERUS, MIN 2V RT	HUMERUS, MIN 2V RT	Radiology	73060	CPT	2001122		Washington Regional Medical Center	outpatient	281	140.5	Cigna	North Carolina PPO-PPA Direct	23.05	23.05	210.75
HUMERUS, MIN 2V RT	HUMERUS, MIN 2V RT	Radiology	73060	CPT	2001122		Washington Regional Medical Center	outpatient	281	140.5	Original Medicare	Traditional Medicare Fee-for-Service	132.07	23.05	210.75
KNEE, 4+ VIEWS LT	KNEE, 4+ VIEWS LT	Radiology	73564	CPT	2001035		Washington Regional Medical Center	outpatient	295	147.5	Self-Pay	Discounted Cash		24.97	221.25
KNEE, 4+ VIEWS LT	KNEE, 4+ VIEWS LT	Radiology	73564	CPT	2001035		Washington Regional Medical Center	outpatient	295	147.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	221.25	24.97	221.25
KNEE, 4+ VIEWS LT	KNEE, 4+ VIEWS LT	Radiology	73564	CPT	2001035		Washington Regional Medical Center	outpatient	295	147.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	129.8	24.97	221.25
KNEE, 4+ VIEWS LT	KNEE, 4+ VIEWS LT	Radiology	73564	CPT	2001035		Washington Regional Medical Center	outpatient	295	147.5	Humana	Medicare Advantage HMO/PPO/PFFS	138.65	24.97	221.25
KNEE, 4+ VIEWS LT	KNEE, 4+ VIEWS LT	Radiology	73564	CPT	2001035		Washington Regional Medical Center	outpatient	295	147.5	AmeriHealth Caritas North Carolina	NC Medicaid	103.72	24.97	221.25
KNEE, 4+ VIEWS LT	KNEE, 4+ VIEWS LT	Radiology	73564	CPT	2001035		Washington Regional Medical Center	outpatient	295	147.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	103.72	24.97	221.25
KNEE, 4+ VIEWS LT	KNEE, 4+ VIEWS LT	Radiology	73564	CPT	2001035		Washington Regional Medical Center	outpatient	295	147.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	103.72	24.97	221.25
KNEE, 4+ VIEWS LT	KNEE, 4+ VIEWS LT	Radiology	73564	CPT	2001035		Washington Regional Medical Center	outpatient	295	147.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	103.72	24.97	221.25
KNEE, 4+ VIEWS LT	KNEE, 4+ VIEWS LT	Radiology	73564	CPT	2001035		Washington Regional Medical Center	outpatient	295	147.5	Cigna	North Carolina PPO-PPA Direct	24.97	24.97	221.25
KNEE, 4+ VIEWS LT	KNEE, 4+ VIEWS LT	Radiology	73564	CPT	2001035		Washington Regional Medical Center	outpatient	295	147.5	Original Medicare	Traditional Medicare Fee-for-Service	138.65	24.97	221.25
KNEE, 4+ VIEWS RT	KNEE, 4+ VIEWS RT	Radiology	73564	CPT	2001111		Washington Regional Medical Center	outpatient	295	147.5	Self-Pay	Discounted Cash		24.97	221.25
KNEE, 4+ VIEWS RT	KNEE, 4+ VIEWS RT	Radiology	73564	CPT	2001111		Washington Regional Medical Center	outpatient	295	147.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	221.25	24.97	221.25
KNEE, 4+ VIEWS RT	KNEE, 4+ VIEWS RT	Radiology	73564	CPT	2001111		Washington Regional Medical Center	outpatient	295	147.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	129.8	24.97	221.25
KNEE, 4+ VIEWS RT	KNEE, 4+ VIEWS RT	Radiology	73564	CPT	2001111		Washington Regional Medical Center	outpatient	295	147.5	Humana	Medicare Advantage HMO/PPO/PFFS	138.65	24.97	221.25
KNEE, 4+ VIEWS RT	KNEE, 4+ VIEWS RT	Radiology	73564	CPT	2001111		Washington Regional Medical Center	outpatient	295	147.5	AmeriHealth Caritas North Carolina	NC Medicaid	103.72	24.97	221.25
KNEE, 4+ VIEWS RT	KNEE, 4+ VIEWS RT	Radiology	73564	CPT	2001111		Washington Regional Medical Center	outpatient	295	147.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	103.72	24.97	221.25
KNEE, 4+ VIEWS RT	KNEE, 4+ VIEWS RT	Radiology	73564	CPT	2001111		Washington Regional Medical Center	outpatient	295	147.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	103.72	24.97	221.25
KNEE, 4+ VIEWS RT	KNEE, 4+ VIEWS RT	Radiology	73564	CPT	2001111		Washington Regional Medical Center	outpatient	295	147.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	103.72	24.97	221.25
KNEE, 4+ VIEWS RT	KNEE, 4+ VIEWS RT	Radiology	73564	CPT	2001111		Washington Regional Medical Center	outpatient	295	147.5	Cigna	North Carolina PPO-PPA Direct	24.97	24.97	221.25
KNEE, 4+ VIEWS RT	KNEE, 4+ VIEWS RT	Radiology	73564	CPT	2001111		Washington Regional Medical Center	outpatient	295	147.5	Original Medicare	Traditional Medicare Fee-for-Service	138.65	24.97	221.25
Mammography of both breasts	MAM BILATERAL DX W/CAD	Radiology	77066	CPT	2401011		Washington Regional Medical Center	outpatient	585	292.5	Self-Pay	Discounted Cash		130.6	438.75
Mammography of both breasts	MAM BILATERAL DX W/CAD	Radiology	77066	CPT	2401011		Washington Regional Medical Center	outpatient	585	292.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	438.75	130.6	438.75
Mammography of both breasts	MAM BILATERAL DX W/CAD	Radiology	77066	CPT	2401011		Washington Regional Medical Center	outpatient	585	292.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	257.4	130.6	438.75
Mammography of both breasts	MAM BILATERAL DX W/CAD	Radiology	77066	CPT	2401011		Washington Regional Medical Center	outpatient	585	292.5	Humana	Medicare Advantage HMO/PPO/PFFS	274.95	130.6	438.75
Mammography of both breasts	MAM BILATERAL DX W/CAD	Radiology	77066	CPT	2401011		Washington Regional Medical Center	outpatient	585	292.5	AmeriHealth Caritas North Carolina	NC Medicaid	205.69	130.6	438.75
Mammography of both breasts	MAM BILATERAL DX W/CAD	Radiology	77066	CPT	2401011		Washington Regional Medical Center	outpatient	585	292.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	205.69	130.6	438.75
Mammography of both breasts	MAM BILATERAL DX W/CAD	Radiology	77066	CPT	2401011		Washington Regional Medical Center	outpatient	585	292.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	205.69	130.6	438.75
Mammography of both breasts	MAM BILATERAL DX W/CAD	Radiology	77066	CPT	2401011		Washington Regional Medical Center	outpatient	585	292.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	205.69	130.6	438.75
Mammography of both breasts	MAM BILATERAL DX W/CAD	Radiology	77066	CPT	2401011		Washington Regional Medical Center	outpatient	585	292.5	Cigna	North Carolina PPO-PPA Direct	130.6	130.6	438.75
Mammography of both breasts	MAM BILATERAL DX W/CAD	Radiology	77066	CPT	2401011		Washington Regional Medical Center	outpatient	585	292.5	Original Medicare	Traditional Medicare Fee-for-Service	274.95	130.6	438.75
Mammography of both breasts	MAM DIAG DIGITAL BILATERAL	Radiology	77066	CPT	2401025		Washington Regional Medical Center	outpatient	585	292.5	Self-Pay	Discounted Cash		130.6	438.75
Mammography of both breasts	MAM DIAG DIGITAL BILATERAL	Radiology	77066	CPT	2401025		Washington Regional Medical Center	outpatient	585	292.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	438.75	130.6	438.75
Mammography of both breasts	MAM DIAG DIGITAL BILATERAL	Radiology	77066	CPT	2401025		Washington Regional Medical Center	outpatient	585	292.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	257.4	130.6	438.75
Mammography of both breasts	MAM DIAG DIGITAL BILATERAL	Radiology	77066	CPT	2401025		Washington Regional Medical Center	outpatient	585	292.5	Humana	Medicare Advantage HMO/PPO/PFFS	274.95	130.6	438.75
Mammography of both breasts	MAM DIAG DIGITAL BILATERAL	Radiology	77066	CPT	2401025		Washington Regional Medical Center	outpatient	585	292.5	AmeriHealth Caritas North Carolina	NC Medicaid	205.69	130.6	438.75
Mammography of both breasts	MAM DIAG DIGITAL BILATERAL	Radiology	77066	CPT	2401025		Washington Regional Medical Center	outpatient	585	292.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	205.69	130.6	438.75
Mammography of both breasts	MAM DIAG DIGITAL BILATERAL	Radiology	77066	CPT	2401025		Washington Regional Medical Center	outpatient	585	292.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	205.69	130.6	438.75
Mammography of both breasts	MAM DIAG DIGITAL BILATERAL	Radiology	77066	CPT	2401025		Washington Regional Medical Center	outpatient	585	292.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	205.69	130.6	438.75
Mammography of both breasts	MAM DIAG DIGITAL BILATERAL	Radiology	77066	CPT	2401025		Washington Regional Medical Center	outpatient	585	292.5	Cigna	North Carolina PPO-PPA Direct	130.6	130.6	438.75
Mammography of both breasts	MAM DIAG DIGITAL BILATERAL	Radiology	77066	CPT	2401025		Washington Regional Medical Center	outpatient	585	292.5	Original Medicare	Traditional Medicare Fee-for-Service	274.95	130.6	438.75
Mammography of one breast	MAM UNILATERAL RT W/CAD	Radiology	77065	CPT	2401009		Washington Regional Medical Center	outpatient	297	148.5	Self-Pay	Discounted Cash		102.07	222.75
Mammography of one breast	MAM UNILATERAL RT W/CAD	Radiology	77065	CPT	2401009		Washington Regional Medical Center	outpatient	297	148.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	222.75	102.07	222.75
Mammography of one breast	MAM UNILATERAL RT W/CAD	Radiology	77065	CPT	2401009		Washington Regional Medical Center	outpatient	297	148.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	130.68	102.07	222.75
Mammography of one breast	MAM UNILATERAL RT W/CAD	Radiology	77065	CPT	2401009		Washington Regional Medical Center	outpatient	297	148.5	Humana	Medicare Advantage HMO/PPO/PFFS	139.59	102.07	222.75
Mammography of one breast	MAM UNILATERAL RT W/CAD	Radiology	77065	CPT	2401009		Washington Regional Medical Center	outpatient	297	148.5	AmeriHealth Caritas North Carolina	NC Medicaid	104.43	102.07	222.75
Mammography of one breast	MAM UNILATERAL RT W/CAD	Radiology	77065	CPT	2401009		Washington Regional Medical Center	outpatient	297	148.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	104.43	102.07	222.75
Mammography of one breast	MAM UNILATERAL RT W/CAD	Radiology	77065	CPT	2401009		Washington Regional Medical Center	outpatient	297	148.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	104.43	102.07	222.75
Mammography of one breast	MAM UNILATERAL RT W/CAD	Radiology	77065	CPT	2401009		Washington Regional Medical Center	outpatient	297	148.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	104.43	102.07	222.75
Mammography of one breast	MAM UNILATERAL RT W/CAD	Radiology	77065	CPT	2401009		Washington Regional Medical Center	outpatient	297	148.5	Cigna	North Carolina PPO-PPA Direct	102.07	102.07	222.75
Mammography of one breast	MAM UNILATERAL RT W/CAD	Radiology	77065	CPT	2401009		Washington Regional Medical Center	outpatient	297	148.5	Original Medicare	Traditional Medicare Fee-for-Service	139.59	102.07	222.75
Mammography of one breast	MAM UNILATERAL LT W/CAD	Radiology	77065	CPT	2401010		Washington Regional Medical Center	outpatient	297	148.5	Self-Pay	Discounted Cash		102.07	222.75
Mammography of one breast	MAM UNILATERAL LT W/CAD	Radiology	77065	CPT	2401010		Washington Regional Medical Center	outpatient	297	148.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	222.75	102.07	222.75
Mammography of one breast	MAM UNILATERAL LT W/CAD	Radiology	77065	CPT	2401010		Washington Regional Medical Center	outpatient	297	148.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	130.68	102.07	222.75
Mammography of one breast	MAM UNILATERAL LT W/CAD	Radiology	77065	CPT	2401010		Washington Regional Medical Center	outpatient	297	148.5	Humana	Medicare Advantage HMO/PPO/PFFS	139.59	102.07	222.75
Mammography of one breast	MAM UNILATERAL LT W/CAD	Radiology	77065	CPT	2401010		Washington Regional Medical Center	outpatient	297	148.5	AmeriHealth Caritas North Carolina	NC Medicaid	104.43	102.07	222.75
Mammography of one breast	MAM UNILATERAL LT W/CAD	Radiology	77065	CPT	2401010		Washington Regional Medical Center	outpatient	297	148.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	104.43	102.07	222.75
Mammography of one breast	MAM UNILATERAL LT W/CAD	Radiology	77065	CPT	2401010		Washington Regional Medical Center	outpatient	297	148.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	104.43	102.07	222.75
Mammography of one breast	MAM UNILATERAL LT W/CAD	Radiology	77065	CPT	2401010		Washington Regional Medical Center	outpatient	297	148.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	104.43	102.07	222.75
Mammography of one breast	MAM UNILATERAL LT W/CAD	Radiology	77065	CPT	2401010		Washington Regional Medical Center	outpatient	297	148.5	Cigna	North Carolina PPO-PPA Direct	102.07	102.07	222.75
Mammography of one breast	MAM UNILATERAL LT W/CAD	Radiology	77065	CPT	2401010		Washington Regional Medical Center	outpatient	297	148.5	Original Medicare	Traditional Medicare Fee-for-Service	139.59	102.07	222.75
Mammography of one breast	MAM DIAG DIGITAL UNILATERAL LT	Radiology	77065	CPT	2401027		Washington Regional Medical Center	outpatient	297	148.5	Self-Pay	Discounted Cash		102.07	222.75
Mammography of one breast	MAM DIAG DIGITAL UNILATERAL LT	Radiology	77065	CPT	2401027		Washington Regional Medical Center	outpatient	297	148.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	222.75	102.07	222.75
Mammography of one breast	MAM DIAG DIGITAL UNILATERAL LT	Radiology	77065	CPT	2401027		Washington Regional Medical Center	outpatient	297	148.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	130.68	102.07	222.75
Mammography of one breast	MAM DIAG DIGITAL UNILATERAL LT	Radiology	77065	CPT	2401027		Washington Regional Medical Center	outpatient	297	148.5	Humana	Medicare Advantage HMO/PPO/PFFS	139.59	102.07	222.75
Mammography of one breast	MAM DIAG DIGITAL UNILATERAL LT	Radiology	77065	CPT	2401027		Washington Regional Medical Center	outpatient	297	148.5	AmeriHealth Caritas North Carolina	NC Medicaid	104.43	102.07	222.75
Mammography of one breast	MAM DIAG DIGITAL UNILATERAL LT	Radiology	77065	CPT	2401027		Washington Regional Medical Center	outpatient	297	148.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	104.43	102.07	222.75
Mammography of one breast	MAM DIAG DIGITAL UNILATERAL LT	Radiology	77065	CPT	2401027		Washington Regional Medical Center	outpatient	297	148.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	104.43	102.07	222.75
Mammography of one breast	MAM DIAG DIGITAL UNILATERAL LT	Radiology	77065	CPT	2401027		Washington Regional Medical Center	outpatient	297	148.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	104.43	102.07	222.75
Mammography of one breast	MAM DIAG DIGITAL UNILATERAL LT	Radiology	77065	CPT	2401027		Washington Regional Medical Center	outpatient	297	148.5	Cigna	North Carolina PPO-PPA Direct	102.07	102.07	222.75
Mammography of one breast	MAM DIAG DIGITAL UNILATERAL LT	Radiology	77065	CPT	2401027		Washington Regional Medical Center	outpatient	297	148.5	Original Medicare	Traditional Medicare Fee-for-Service	139.59	102.07	222.75
Mammography of one breast	MAM DIAG DIGITAL UNILATERAL RT	Radiology	77065	CPT	2401028		Washington Regional Medical Center	outpatient	297	148.5	Self-Pay	Discounted Cash		102.07	222.75
Mammography of one breast	MAM DIAG DIGITAL UNILATERAL RT	Radiology	77065	CPT	2401028		Washington Regional Medical Center	outpatient	297	148.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	222.75	102.07	222.75
Mammography of one breast	MAM DIAG DIGITAL UNILATERAL RT	Radiology	77065	CPT	2401028		Washington Regional Medical Center	outpatient	297	148.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	130.68	102.07	222.75
Mammography of one breast	MAM DIAG DIGITAL UNILATERAL RT	Radiology	77065	CPT	2401028		Washington Regional Medical Center	outpatient	297	148.5	Humana	Medicare Advantage HMO/PPO/PFFS	139.59	102.07	222.75
Mammography of one breast	MAM DIAG DIGITAL UNILATERAL RT	Radiology	77065	CPT	2401028		Washington Regional Medical Center	outpatient	297	148.5	AmeriHealth Caritas North Carolina	NC Medicaid	104.43	102.07	222.75
Mammography of one breast	MAM DIAG DIGITAL UNILATERAL RT	Radiology	77065	CPT	2401028		Washington Regional Medical Center	outpatient	297	148.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	104.43	102.07	222.75
Mammography of one breast	MAM DIAG DIGITAL UNILATERAL RT	Radiology	77065	CPT	2401028		Washington Regional Medical Center	outpatient	297	148.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	104.43	102.07	222.75
Mammography of one breast	MAM DIAG DIGITAL UNILATERAL RT	Radiology	77065	CPT	2401028		Washington Regional Medical Center	outpatient	297	148.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	104.43	102.07	222.75
Mammography of one breast	MAM DIAG DIGITAL UNILATERAL RT	Radiology	77065	CPT	2401028		Washington Regional Medical Center	outpatient	297	148.5	Cigna	North Carolina PPO-PPA Direct	102.07	102.07	222.75
Mammography of one breast	MAM DIAG DIGITAL UNILATERAL RT	Radiology	77065	CPT	2401028		Washington Regional Medical Center	outpatient	297	148.5	Original Medicare	Traditional Medicare Fee-for-Service	139.59	102.07	222.75
Mammography, screening, bilateral	MAM SCRN BILA EA/ W/CAD	Radiology	77067	CPT	2401012		Washington Regional Medical Center	outpatient	530	265	Self-Pay	Discounted Cash		107.85	397.5
Mammography, screening, bilateral	MAM SCRN BILA EA/ W/CAD	Radiology	77067	CPT	2401012		Washington Regional Medical Center	outpatient	530	265	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	397.5	107.85	397.5
Mammography, screening, bilateral	MAM SCRN BILA EA/ W/CAD	Radiology	77067	CPT	2401012		Washington Regional Medical Center	outpatient	530	265	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	233.2	107.85	397.5
Mammography, screening, bilateral	MAM SCRN BILA EA/ W/CAD	Radiology	77067	CPT	2401012		Washington Regional Medical Center	outpatient	530	265	Humana	Medicare Advantage HMO/PPO/PFFS	249.1	107.85	397.5
Mammography, screening, bilateral	MAM SCRN BILA EA/ W/CAD	Radiology	77067	CPT	2401012		Washington Regional Medical Center	outpatient	530	265	AmeriHealth Caritas North Carolina	NC Medicaid	186.35	107.85	397.5
Mammography, screening, bilateral	MAM SCRN BILA EA/ W/CAD	Radiology	77067	CPT	2401012		Washington Regional Medical Center	outpatient	530	265	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	186.35	107.85	397.5
Mammography, screening, bilateral	MAM SCRN BILA EA/ W/CAD	Radiology	77067	CPT	2401012		Washington Regional Medical Center	outpatient	530	265	WellCare of North Carolina	North Carolina Medicaid/CHIP	186.35	107.85	397.5
Mammography, screening, bilateral	MAM SCRN BILA EA/ W/CAD	Radiology	77067	CPT	2401012		Washington Regional Medical Center	outpatient	530	265	Healthy Blue / Blue Cross NC	North Carolina Medicaid	186.35	107.85	397.5
Mammography, screening, bilateral	MAM SCRN BILA EA/ W/CAD	Radiology	77067	CPT	2401012		Washington Regional Medical Center	outpatient	530	265	Cigna	North Carolina PPO-PPA Direct	107.85	107.85	397.5
Mammography, screening, bilateral	MAM SCRN BILA EA/ W/CAD	Radiology	77067	CPT	2401012		Washington Regional Medical Center	outpatient	530	265	Original Medicare	Traditional Medicare Fee-for-Service	249.1	107.85	397.5
Mammography, screening, bilateral	MAM DIGITAL SCR RT W/CAD	Radiology	77067	CPT	2401019		Washington Regional Medical Center	outpatient	530	265	Self-Pay	Discounted Cash		107.85	397.5
Mammography, screening, bilateral	MAM DIGITAL SCR RT W/CAD	Radiology	77067	CPT	2401019		Washington Regional Medical Center	outpatient	530	265	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	397.5	107.85	397.5
Mammography, screening, bilateral	MAM DIGITAL SCR RT W/CAD	Radiology	77067	CPT	2401019		Washington Regional Medical Center	outpatient	530	265	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	233.2	107.85	397.5
Mammography, screening, bilateral	MAM DIGITAL SCR RT W/CAD	Radiology	77067	CPT	2401019		Washington Regional Medical Center	outpatient	530	265	Humana	Medicare Advantage HMO/PPO/PFFS	249.1	107.85	397.5
Mammography, screening, bilateral	MAM DIGITAL SCR RT W/CAD	Radiology	77067	CPT	2401019		Washington Regional Medical Center	outpatient	530	265	AmeriHealth Caritas North Carolina	NC Medicaid	186.35	107.85	397.5
Mammography, screening, bilateral	MAM DIGITAL SCR RT W/CAD	Radiology	77067	CPT	2401019		Washington Regional Medical Center	outpatient	530	265	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	186.35	107.85	397.5
Mammography, screening, bilateral	MAM DIGITAL SCR RT W/CAD	Radiology	77067	CPT	2401019		Washington Regional Medical Center	outpatient	530	265	WellCare of North Carolina	North Carolina Medicaid/CHIP	186.35	107.85	397.5
Mammography, screening, bilateral	MAM DIGITAL SCR RT W/CAD	Radiology	77067	CPT	2401019		Washington Regional Medical Center	outpatient	530	265	Healthy Blue / Blue Cross NC	North Carolina Medicaid	186.35	107.85	397.5
Mammography, screening, bilateral	MAM DIGITAL SCR RT W/CAD	Radiology	77067	CPT	2401019		Washington Regional Medical Center	outpatient	530	265	Cigna	North Carolina PPO-PPA Direct	107.85	107.85	397.5
Mammography, screening, bilateral	MAM DIGITAL SCR RT W/CAD	Radiology	77067	CPT	2401019		Washington Regional Medical Center	outpatient	530	265	Original Medicare	Traditional Medicare Fee-for-Service	249.1	107.85	397.5
Mammography, screening, bilateral	MAM DIGITAL SCR LT W/CAD	Radiology	77067	CPT	2401020		Washington Regional Medical Center	outpatient	530	265	Self-Pay	Discounted Cash		107.85	397.5
Mammography, screening, bilateral	MAM DIGITAL SCR LT W/CAD	Radiology	77067	CPT	2401020		Washington Regional Medical Center	outpatient	530	265	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	397.5	107.85	397.5
Mammography, screening, bilateral	MAM DIGITAL SCR LT W/CAD	Radiology	77067	CPT	2401020		Washington Regional Medical Center	outpatient	530	265	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	233.2	107.85	397.5
Mammography, screening, bilateral	MAM DIGITAL SCR LT W/CAD	Radiology	77067	CPT	2401020		Washington Regional Medical Center	outpatient	530	265	Humana	Medicare Advantage HMO/PPO/PFFS	249.1	107.85	397.5
Mammography, screening, bilateral	MAM DIGITAL SCR LT W/CAD	Radiology	77067	CPT	2401020		Washington Regional Medical Center	outpatient	530	265	AmeriHealth Caritas North Carolina	NC Medicaid	186.35	107.85	397.5
Mammography, screening, bilateral	MAM DIGITAL SCR LT W/CAD	Radiology	77067	CPT	2401020		Washington Regional Medical Center	outpatient	530	265	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	186.35	107.85	397.5
Mammography, screening, bilateral	MAM DIGITAL SCR LT W/CAD	Radiology	77067	CPT	2401020		Washington Regional Medical Center	outpatient	530	265	WellCare of North Carolina	North Carolina Medicaid/CHIP	186.35	107.85	397.5
Mammography, screening, bilateral	MAM DIGITAL SCR LT W/CAD	Radiology	77067	CPT	2401020		Washington Regional Medical Center	outpatient	530	265	Healthy Blue / Blue Cross NC	North Carolina Medicaid	186.35	107.85	397.5
Mammography, screening, bilateral	MAM DIGITAL SCR LT W/CAD	Radiology	77067	CPT	2401020		Washington Regional Medical Center	outpatient	530	265	Cigna	North Carolina PPO-PPA Direct	107.85	107.85	397.5
Mammography, screening, bilateral	MAM DIGITAL SCR LT W/CAD	Radiology	77067	CPT	2401020		Washington Regional Medical Center	outpatient	530	265	Original Medicare	Traditional Medicare Fee-for-Service	249.1	107.85	397.5
Mammography, screening, bilateral	MAM SCR DIG 3D UNILATERAL LT	Radiology	77067	CPT	2401023		Washington Regional Medical Center	outpatient	530	265	Self-Pay	Discounted Cash		107.85	397.5
Mammography, screening, bilateral	MAM SCR DIG 3D UNILATERAL LT	Radiology	77067	CPT	2401023		Washington Regional Medical Center	outpatient	530	265	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	397.5	107.85	397.5
Mammography, screening, bilateral	MAM SCR DIG 3D UNILATERAL LT	Radiology	77067	CPT	2401023		Washington Regional Medical Center	outpatient	530	265	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	233.2	107.85	397.5
Mammography, screening, bilateral	MAM SCR DIG 3D UNILATERAL LT	Radiology	77067	CPT	2401023		Washington Regional Medical Center	outpatient	530	265	Humana	Medicare Advantage HMO/PPO/PFFS	249.1	107.85	397.5
Mammography, screening, bilateral	MAM SCR DIG 3D UNILATERAL LT	Radiology	77067	CPT	2401023		Washington Regional Medical Center	outpatient	530	265	AmeriHealth Caritas North Carolina	NC Medicaid	186.35	107.85	397.5
Mammography, screening, bilateral	MAM SCR DIG 3D UNILATERAL LT	Radiology	77067	CPT	2401023		Washington Regional Medical Center	outpatient	530	265	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	186.35	107.85	397.5
Mammography, screening, bilateral	MAM SCR DIG 3D UNILATERAL LT	Radiology	77067	CPT	2401023		Washington Regional Medical Center	outpatient	530	265	WellCare of North Carolina	North Carolina Medicaid/CHIP	186.35	107.85	397.5
Mammography, screening, bilateral	MAM SCR DIG 3D UNILATERAL LT	Radiology	77067	CPT	2401023		Washington Regional Medical Center	outpatient	530	265	Healthy Blue / Blue Cross NC	North Carolina Medicaid	186.35	107.85	397.5
Mammography, screening, bilateral	MAM SCR DIG 3D UNILATERAL LT	Radiology	77067	CPT	2401023		Washington Regional Medical Center	outpatient	530	265	Cigna	North Carolina PPO-PPA Direct	107.85	107.85	397.5
Mammography, screening, bilateral	MAM SCR DIG 3D UNILATERAL LT	Radiology	77067	CPT	2401023		Washington Regional Medical Center	outpatient	530	265	Original Medicare	Traditional Medicare Fee-for-Service	249.1	107.85	397.5
Mammography, screening, bilateral	MAM SCR DIG 3D UNILATERAL RT	Radiology	77067	CPT	2401024		Washington Regional Medical Center	outpatient	530	265	Self-Pay	Discounted Cash		107.85	397.5
Mammography, screening, bilateral	MAM SCR DIG 3D UNILATERAL RT	Radiology	77067	CPT	2401024		Washington Regional Medical Center	outpatient	530	265	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	397.5	107.85	397.5
Mammography, screening, bilateral	MAM SCR DIG 3D UNILATERAL RT	Radiology	77067	CPT	2401024		Washington Regional Medical Center	outpatient	530	265	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	233.2	107.85	397.5
Mammography, screening, bilateral	MAM SCR DIG 3D UNILATERAL RT	Radiology	77067	CPT	2401024		Washington Regional Medical Center	outpatient	530	265	Humana	Medicare Advantage HMO/PPO/PFFS	249.1	107.85	397.5
Mammography, screening, bilateral	MAM SCR DIG 3D UNILATERAL RT	Radiology	77067	CPT	2401024		Washington Regional Medical Center	outpatient	530	265	AmeriHealth Caritas North Carolina	NC Medicaid	186.35	107.85	397.5
Mammography, screening, bilateral	MAM SCR DIG 3D UNILATERAL RT	Radiology	77067	CPT	2401024		Washington Regional Medical Center	outpatient	530	265	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	186.35	107.85	397.5
Mammography, screening, bilateral	MAM SCR DIG 3D UNILATERAL RT	Radiology	77067	CPT	2401024		Washington Regional Medical Center	outpatient	530	265	WellCare of North Carolina	North Carolina Medicaid/CHIP	186.35	107.85	397.5
Mammography, screening, bilateral	MAM SCR DIG 3D UNILATERAL RT	Radiology	77067	CPT	2401024		Washington Regional Medical Center	outpatient	530	265	Healthy Blue / Blue Cross NC	North Carolina Medicaid	186.35	107.85	397.5
Mammography, screening, bilateral	MAM SCR DIG 3D UNILATERAL RT	Radiology	77067	CPT	2401024		Washington Regional Medical Center	outpatient	530	265	Cigna	North Carolina PPO-PPA Direct	107.85	107.85	397.5
Mammography, screening, bilateral	MAM SCR DIG 3D UNILATERAL RT	Radiology	77067	CPT	2401024		Washington Regional Medical Center	outpatient	530	265	Original Medicare	Traditional Medicare Fee-for-Service	249.1	107.85	397.5
Mammography, screening, bilateral	MM SCREEN 2D BILATERAL	Radiology	77067	CPT	2401032		Washington Regional Medical Center	outpatient	530	265	Self-Pay	Discounted Cash		107.85	397.5
Mammography, screening, bilateral	MM SCREEN 2D BILATERAL	Radiology	77067	CPT	2401032		Washington Regional Medical Center	outpatient	530	265	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	397.5	107.85	397.5
Mammography, screening, bilateral	MM SCREEN 2D BILATERAL	Radiology	77067	CPT	2401032		Washington Regional Medical Center	outpatient	530	265	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	233.2	107.85	397.5
Mammography, screening, bilateral	MM SCREEN 2D BILATERAL	Radiology	77067	CPT	2401032		Washington Regional Medical Center	outpatient	530	265	Humana	Medicare Advantage HMO/PPO/PFFS	249.1	107.85	397.5
Mammography, screening, bilateral	MM SCREEN 2D BILATERAL	Radiology	77067	CPT	2401032		Washington Regional Medical Center	outpatient	530	265	AmeriHealth Caritas North Carolina	NC Medicaid	186.35	107.85	397.5
Mammography, screening, bilateral	MM SCREEN 2D BILATERAL	Radiology	77067	CPT	2401032		Washington Regional Medical Center	outpatient	530	265	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	186.35	107.85	397.5
Mammography, screening, bilateral	MM SCREEN 2D BILATERAL	Radiology	77067	CPT	2401032		Washington Regional Medical Center	outpatient	530	265	WellCare of North Carolina	North Carolina Medicaid/CHIP	186.35	107.85	397.5
Mammography, screening, bilateral	MM SCREEN 2D BILATERAL	Radiology	77067	CPT	2401032		Washington Regional Medical Center	outpatient	530	265	Healthy Blue / Blue Cross NC	North Carolina Medicaid	186.35	107.85	397.5
Mammography, screening, bilateral	MM SCREEN 2D BILATERAL	Radiology	77067	CPT	2401032		Washington Regional Medical Center	outpatient	530	265	Cigna	North Carolina PPO-PPA Direct	107.85	107.85	397.5
Mammography, screening, bilateral	MM SCREEN 2D BILATERAL	Radiology	77067	CPT	2401032		Washington Regional Medical Center	outpatient	530	265	Original Medicare	Traditional Medicare Fee-for-Service	249.1	107.85	397.5
MASTOIDS < 3V PER SIDE	MASTOIDS < 3V PER SIDE	Radiology	70120	CPT	2001055		Washington Regional Medical Center	outpatient	298	149	Self-Pay	Discounted Cash		24.97	223.5
MASTOIDS < 3V PER SIDE	MASTOIDS < 3V PER SIDE	Radiology	70120	CPT	2001055		Washington Regional Medical Center	outpatient	298	149	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	223.5	24.97	223.5
MASTOIDS < 3V PER SIDE	MASTOIDS < 3V PER SIDE	Radiology	70120	CPT	2001055		Washington Regional Medical Center	outpatient	298	149	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	131.12	24.97	223.5
MASTOIDS < 3V PER SIDE	MASTOIDS < 3V PER SIDE	Radiology	70120	CPT	2001055		Washington Regional Medical Center	outpatient	298	149	Humana	Medicare Advantage HMO/PPO/PFFS	140.06	24.97	223.5
MASTOIDS < 3V PER SIDE	MASTOIDS < 3V PER SIDE	Radiology	70120	CPT	2001055		Washington Regional Medical Center	outpatient	298	149	AmeriHealth Caritas North Carolina	NC Medicaid	104.78	24.97	223.5
MASTOIDS < 3V PER SIDE	MASTOIDS < 3V PER SIDE	Radiology	70120	CPT	2001055		Washington Regional Medical Center	outpatient	298	149	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	104.78	24.97	223.5
MASTOIDS < 3V PER SIDE	MASTOIDS < 3V PER SIDE	Radiology	70120	CPT	2001055		Washington Regional Medical Center	outpatient	298	149	WellCare of North Carolina	North Carolina Medicaid/CHIP	104.78	24.97	223.5
MASTOIDS < 3V PER SIDE	MASTOIDS < 3V PER SIDE	Radiology	70120	CPT	2001055		Washington Regional Medical Center	outpatient	298	149	Healthy Blue / Blue Cross NC	North Carolina Medicaid	104.78	24.97	223.5
MASTOIDS < 3V PER SIDE	MASTOIDS < 3V PER SIDE	Radiology	70120	CPT	2001055		Washington Regional Medical Center	outpatient	298	149	Cigna	North Carolina PPO-PPA Direct	24.97	24.97	223.5
MASTOIDS < 3V PER SIDE	MASTOIDS < 3V PER SIDE	Radiology	70120	CPT	2001055		Washington Regional Medical Center	outpatient	298	149	Original Medicare	Traditional Medicare Fee-for-Service	140.06	24.97	223.5
MM ADD 3D	MM ADD 3D	Radiology	77062	CPT	2401034		Washington Regional Medical Center	outpatient	375	187.5	Self-Pay	Discounted Cash		101.3	281.25
MM ADD 3D	MM ADD 3D	Radiology	77062	CPT	2401034		Washington Regional Medical Center	outpatient	375	187.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	281.25	101.3	281.25
MM ADD 3D	MM ADD 3D	Radiology	77062	CPT	2401034		Washington Regional Medical Center	outpatient	375	187.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	165	101.3	281.25
MM ADD 3D	MM ADD 3D	Radiology	77062	CPT	2401034		Washington Regional Medical Center	outpatient	375	187.5	Humana	Medicare Advantage HMO/PPO/PFFS	176.25	101.3	281.25
MM ADD 3D	MM ADD 3D	Radiology	77062	CPT	2401034		Washington Regional Medical Center	outpatient	375	187.5	AmeriHealth Caritas North Carolina	NC Medicaid	131.85	101.3	281.25
MM ADD 3D	MM ADD 3D	Radiology	77062	CPT	2401034		Washington Regional Medical Center	outpatient	375	187.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	131.85	101.3	281.25
MM ADD 3D	MM ADD 3D	Radiology	77062	CPT	2401034		Washington Regional Medical Center	outpatient	375	187.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	131.85	101.3	281.25
MM ADD 3D	MM ADD 3D	Radiology	77062	CPT	2401034		Washington Regional Medical Center	outpatient	375	187.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	131.85	101.3	281.25
MM ADD 3D	MM ADD 3D	Radiology	77062	CPT	2401034		Washington Regional Medical Center	outpatient	375	187.5	Cigna	North Carolina PPO-PPA Direct	101.3	101.3	281.25
MM ADD 3D	MM ADD 3D	Radiology	77062	CPT	2401034		Washington Regional Medical Center	outpatient	375	187.5	Original Medicare	Traditional Medicare Fee-for-Service	176.25	101.3	281.25
MR ABD W/C	MR ABD W/C	Radiology	74182	CPT	2301056		Washington Regional Medical Center	outpatient	2366	1183	Self-Pay	Discounted Cash		532.13	1774.5
MR ABD W/C	MR ABD W/C	Radiology	74182	CPT	2301056		Washington Regional Medical Center	outpatient	2366	1183	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1774.5	532.13	1774.5
MR ABD W/C	MR ABD W/C	Radiology	74182	CPT	2301056		Washington Regional Medical Center	outpatient	2366	1183	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	1041.04	532.13	1774.5
MR ABD W/C	MR ABD W/C	Radiology	74182	CPT	2301056		Washington Regional Medical Center	outpatient	2366	1183	Humana	Medicare Advantage HMO/PPO/PFFS	1112.02	532.13	1774.5
MR ABD W/C	MR ABD W/C	Radiology	74182	CPT	2301056		Washington Regional Medical Center	outpatient	2366	1183	AmeriHealth Caritas North Carolina	NC Medicaid	831.89	532.13	1774.5
MR ABD W/C	MR ABD W/C	Radiology	74182	CPT	2301056		Washington Regional Medical Center	outpatient	2366	1183	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	831.89	532.13	1774.5
MR ABD W/C	MR ABD W/C	Radiology	74182	CPT	2301056		Washington Regional Medical Center	outpatient	2366	1183	WellCare of North Carolina	North Carolina Medicaid/CHIP	831.89	532.13	1774.5
MR ABD W/C	MR ABD W/C	Radiology	74182	CPT	2301056		Washington Regional Medical Center	outpatient	2366	1183	Healthy Blue / Blue Cross NC	North Carolina Medicaid	831.89	532.13	1774.5
MR ABD W/C	MR ABD W/C	Radiology	74182	CPT	2301056		Washington Regional Medical Center	outpatient	2366	1183	Cigna	North Carolina PPO-PPA Direct	532.13	532.13	1774.5
MR ABD W/C	MR ABD W/C	Radiology	74182	CPT	2301056		Washington Regional Medical Center	outpatient	2366	1183	Original Medicare	Traditional Medicare Fee-for-Service	1112.02	532.13	1774.5
MR CHEST W/O	MR CHEST W/O	Radiology	71550	CPT	2301019		Washington Regional Medical Center	outpatient	219	109.5	Self-Pay	Discounted Cash		77	443.89
MR CHEST W/O	MR CHEST W/O	Radiology	71550	CPT	2301019		Washington Regional Medical Center	outpatient	219	109.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	164.25	77	443.89
MR CHEST W/O	MR CHEST W/O	Radiology	71550	CPT	2301019		Washington Regional Medical Center	outpatient	219	109.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	96.36	77	443.89
MR CHEST W/O	MR CHEST W/O	Radiology	71550	CPT	2301019		Washington Regional Medical Center	outpatient	219	109.5	Humana	Medicare Advantage HMO/PPO/PFFS	102.93	77	443.89
MR CHEST W/O	MR CHEST W/O	Radiology	71550	CPT	2301019		Washington Regional Medical Center	outpatient	219	109.5	AmeriHealth Caritas North Carolina	NC Medicaid	77	77	443.89
MR CHEST W/O	MR CHEST W/O	Radiology	71550	CPT	2301019		Washington Regional Medical Center	outpatient	219	109.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	77	77	443.89
MR CHEST W/O	MR CHEST W/O	Radiology	71550	CPT	2301019		Washington Regional Medical Center	outpatient	219	109.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	77	77	443.89
MR CHEST W/O	MR CHEST W/O	Radiology	71550	CPT	2301019		Washington Regional Medical Center	outpatient	219	109.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	77	77	443.89
MR CHEST W/O	MR CHEST W/O	Radiology	71550	CPT	2301019		Washington Regional Medical Center	outpatient	219	109.5	Cigna	North Carolina PPO-PPA Direct	443.89	77	443.89
MR CHEST W/O	MR CHEST W/O	Radiology	71550	CPT	2301019		Washington Regional Medical Center	outpatient	219	109.5	Original Medicare	Traditional Medicare Fee-for-Service	102.93	77	443.89
MR FACE/NECK W/C	MR FACE/NECK W/C	Radiology	70542	CPT	2301058		Washington Regional Medical Center	outpatient	509	254.5	Self-Pay	Discounted Cash		178.96	530.8
MR FACE/NECK W/C	MR FACE/NECK W/C	Radiology	70542	CPT	2301058		Washington Regional Medical Center	outpatient	509	254.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	381.75	178.96	530.8
MR FACE/NECK W/C	MR FACE/NECK W/C	Radiology	70542	CPT	2301058		Washington Regional Medical Center	outpatient	509	254.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	223.96	178.96	530.8
MR FACE/NECK W/C	MR FACE/NECK W/C	Radiology	70542	CPT	2301058		Washington Regional Medical Center	outpatient	509	254.5	Humana	Medicare Advantage HMO/PPO/PFFS	239.23	178.96	530.8
MR FACE/NECK W/C	MR FACE/NECK W/C	Radiology	70542	CPT	2301058		Washington Regional Medical Center	outpatient	509	254.5	AmeriHealth Caritas North Carolina	NC Medicaid	178.96	178.96	530.8
MR FACE/NECK W/C	MR FACE/NECK W/C	Radiology	70542	CPT	2301058		Washington Regional Medical Center	outpatient	509	254.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	178.96	178.96	530.8
MR FACE/NECK W/C	MR FACE/NECK W/C	Radiology	70542	CPT	2301058		Washington Regional Medical Center	outpatient	509	254.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	178.96	178.96	530.8
MR FACE/NECK W/C	MR FACE/NECK W/C	Radiology	70542	CPT	2301058		Washington Regional Medical Center	outpatient	509	254.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	178.96	178.96	530.8
MR FACE/NECK W/C	MR FACE/NECK W/C	Radiology	70542	CPT	2301058		Washington Regional Medical Center	outpatient	509	254.5	Cigna	North Carolina PPO-PPA Direct	530.8	178.96	530.8
MR FACE/NECK W/C	MR FACE/NECK W/C	Radiology	70542	CPT	2301058		Washington Regional Medical Center	outpatient	509	254.5	Original Medicare	Traditional Medicare Fee-for-Service	239.23	178.96	530.8
MR PELVIS W/O	MR PELVIS W/O	Radiology	72195	CPT	2301036		Washington Regional Medical Center	outpatient	229	114.5	Self-Pay	Discounted Cash		80.52	443.89
MR PELVIS W/O	MR PELVIS W/O	Radiology	72195	CPT	2301036		Washington Regional Medical Center	outpatient	229	114.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	171.75	80.52	443.89
MR PELVIS W/O	MR PELVIS W/O	Radiology	72195	CPT	2301036		Washington Regional Medical Center	outpatient	229	114.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	100.76	80.52	443.89
MR PELVIS W/O	MR PELVIS W/O	Radiology	72195	CPT	2301036		Washington Regional Medical Center	outpatient	229	114.5	Humana	Medicare Advantage HMO/PPO/PFFS	107.63	80.52	443.89
MR PELVIS W/O	MR PELVIS W/O	Radiology	72195	CPT	2301036		Washington Regional Medical Center	outpatient	229	114.5	AmeriHealth Caritas North Carolina	NC Medicaid	80.52	80.52	443.89
MR PELVIS W/O	MR PELVIS W/O	Radiology	72195	CPT	2301036		Washington Regional Medical Center	outpatient	229	114.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	80.52	80.52	443.89
MR PELVIS W/O	MR PELVIS W/O	Radiology	72195	CPT	2301036		Washington Regional Medical Center	outpatient	229	114.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	80.52	80.52	443.89
MR PELVIS W/O	MR PELVIS W/O	Radiology	72195	CPT	2301036		Washington Regional Medical Center	outpatient	229	114.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	80.52	80.52	443.89
MR PELVIS W/O	MR PELVIS W/O	Radiology	72195	CPT	2301036		Washington Regional Medical Center	outpatient	229	114.5	Cigna	North Carolina PPO-PPA Direct	443.89	80.52	443.89
MR PELVIS W/O	MR PELVIS W/O	Radiology	72195	CPT	2301036		Washington Regional Medical Center	outpatient	229	114.5	Original Medicare	Traditional Medicare Fee-for-Service	107.63	80.52	443.89
MR T-SPINE W/O	MR T-SPINE W/O	Radiology	72146	CPT	2301065		Washington Regional Medical Center	outpatient	293	146.5	Self-Pay	Discounted Cash		103.02	496.77
MR T-SPINE W/O	MR T-SPINE W/O	Radiology	72146	CPT	2301065		Washington Regional Medical Center	outpatient	293	146.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	219.75	103.02	496.77
MR T-SPINE W/O	MR T-SPINE W/O	Radiology	72146	CPT	2301065		Washington Regional Medical Center	outpatient	293	146.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	128.92	103.02	496.77
MR T-SPINE W/O	MR T-SPINE W/O	Radiology	72146	CPT	2301065		Washington Regional Medical Center	outpatient	293	146.5	Humana	Medicare Advantage HMO/PPO/PFFS	137.71	103.02	496.77
MR T-SPINE W/O	MR T-SPINE W/O	Radiology	72146	CPT	2301065		Washington Regional Medical Center	outpatient	293	146.5	AmeriHealth Caritas North Carolina	NC Medicaid	103.02	103.02	496.77
MR T-SPINE W/O	MR T-SPINE W/O	Radiology	72146	CPT	2301065		Washington Regional Medical Center	outpatient	293	146.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	103.02	103.02	496.77
MR T-SPINE W/O	MR T-SPINE W/O	Radiology	72146	CPT	2301065		Washington Regional Medical Center	outpatient	293	146.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	103.02	103.02	496.77
MR T-SPINE W/O	MR T-SPINE W/O	Radiology	72146	CPT	2301065		Washington Regional Medical Center	outpatient	293	146.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	103.02	103.02	496.77
MR T-SPINE W/O	MR T-SPINE W/O	Radiology	72146	CPT	2301065		Washington Regional Medical Center	outpatient	293	146.5	Cigna	North Carolina PPO-PPA Direct	496.77	103.02	496.77
MR T-SPINE W/O	MR T-SPINE W/O	Radiology	72146	CPT	2301065		Washington Regional Medical Center	outpatient	293	146.5	Original Medicare	Traditional Medicare Fee-for-Service	137.71	103.02	496.77
MRI scan of brain before and after contrast	MRI scan of brain before and after contrast	Radiology	70553	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
MRI scan of leg joint	MRI scan of leg joint	Radiology	73721	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
MRI scan of lower spinal canal	MRI scan of lower spinal canal	Radiology	72148	CPT/HCPCS			Washington Regional Medical Center	Not offered			Not Applicable	CMS-specified service not offered
NECK (SOFT TISSUE)	NECK (SOFT TISSUE)	Radiology	70360	CPT	2001154		Washington Regional Medical Center	outpatient	227	113.5	Self-Pay	Discounted Cash		16.73	170.25
NECK (SOFT TISSUE)	NECK (SOFT TISSUE)	Radiology	70360	CPT	2001154		Washington Regional Medical Center	outpatient	227	113.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	170.25	16.73	170.25
NECK (SOFT TISSUE)	NECK (SOFT TISSUE)	Radiology	70360	CPT	2001154		Washington Regional Medical Center	outpatient	227	113.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	99.88	16.73	170.25
NECK (SOFT TISSUE)	NECK (SOFT TISSUE)	Radiology	70360	CPT	2001154		Washington Regional Medical Center	outpatient	227	113.5	Humana	Medicare Advantage HMO/PPO/PFFS	106.69	16.73	170.25
NECK (SOFT TISSUE)	NECK (SOFT TISSUE)	Radiology	70360	CPT	2001154		Washington Regional Medical Center	outpatient	227	113.5	AmeriHealth Caritas North Carolina	NC Medicaid	79.81	16.73	170.25
NECK (SOFT TISSUE)	NECK (SOFT TISSUE)	Radiology	70360	CPT	2001154		Washington Regional Medical Center	outpatient	227	113.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	79.81	16.73	170.25
NECK (SOFT TISSUE)	NECK (SOFT TISSUE)	Radiology	70360	CPT	2001154		Washington Regional Medical Center	outpatient	227	113.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	79.81	16.73	170.25
NECK (SOFT TISSUE)	NECK (SOFT TISSUE)	Radiology	70360	CPT	2001154		Washington Regional Medical Center	outpatient	227	113.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	79.81	16.73	170.25
NECK (SOFT TISSUE)	NECK (SOFT TISSUE)	Radiology	70360	CPT	2001154		Washington Regional Medical Center	outpatient	227	113.5	Cigna	North Carolina PPO-PPA Direct	16.73	16.73	170.25
NECK (SOFT TISSUE)	NECK (SOFT TISSUE)	Radiology	70360	CPT	2001154		Washington Regional Medical Center	outpatient	227	113.5	Original Medicare	Traditional Medicare Fee-for-Service	106.69	16.73	170.25
NEPHROTOMOGRAM	NEPHROTOMOGRAM	Radiology	74415	CPT	2001108		Washington Regional Medical Center	outpatient	585	292.5	Self-Pay	Discounted Cash		84.95	438.75
NEPHROTOMOGRAM	NEPHROTOMOGRAM	Radiology	74415	CPT	2001108		Washington Regional Medical Center	outpatient	585	292.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	438.75	84.95	438.75
NEPHROTOMOGRAM	NEPHROTOMOGRAM	Radiology	74415	CPT	2001108		Washington Regional Medical Center	outpatient	585	292.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	257.4	84.95	438.75
NEPHROTOMOGRAM	NEPHROTOMOGRAM	Radiology	74415	CPT	2001108		Washington Regional Medical Center	outpatient	585	292.5	Humana	Medicare Advantage HMO/PPO/PFFS	274.95	84.95	438.75
NEPHROTOMOGRAM	NEPHROTOMOGRAM	Radiology	74415	CPT	2001108		Washington Regional Medical Center	outpatient	585	292.5	AmeriHealth Caritas North Carolina	NC Medicaid	205.69	84.95	438.75
NEPHROTOMOGRAM	NEPHROTOMOGRAM	Radiology	74415	CPT	2001108		Washington Regional Medical Center	outpatient	585	292.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	205.69	84.95	438.75
NEPHROTOMOGRAM	NEPHROTOMOGRAM	Radiology	74415	CPT	2001108		Washington Regional Medical Center	outpatient	585	292.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	205.69	84.95	438.75
NEPHROTOMOGRAM	NEPHROTOMOGRAM	Radiology	74415	CPT	2001108		Washington Regional Medical Center	outpatient	585	292.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	205.69	84.95	438.75
NEPHROTOMOGRAM	NEPHROTOMOGRAM	Radiology	74415	CPT	2001108		Washington Regional Medical Center	outpatient	585	292.5	Cigna	North Carolina PPO-PPA Direct	84.95	84.95	438.75
NEPHROTOMOGRAM	NEPHROTOMOGRAM	Radiology	74415	CPT	2001108		Washington Regional Medical Center	outpatient	585	292.5	Original Medicare	Traditional Medicare Fee-for-Service	274.95	84.95	438.75
Ob Us Detailed One Fetus 76811	Ob Us Detailed One Fetus 76811	Radiology	76811	CPT	2727329		Washington Regional Medical Center	outpatient	819	409.5	Self-Pay	Discounted Cash		147.59	614.25
Ob Us Detailed One Fetus 76811	Ob Us Detailed One Fetus 76811	Radiology	76811	CPT	2727329		Washington Regional Medical Center	outpatient	819	409.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	614.25	147.59	614.25
Ob Us Detailed One Fetus 76811	Ob Us Detailed One Fetus 76811	Radiology	76811	CPT	2727329		Washington Regional Medical Center	outpatient	819	409.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	360.36	147.59	614.25
Ob Us Detailed One Fetus 76811	Ob Us Detailed One Fetus 76811	Radiology	76811	CPT	2727329		Washington Regional Medical Center	outpatient	819	409.5	Humana	Medicare Advantage HMO/PPO/PFFS	384.93	147.59	614.25
Ob Us Detailed One Fetus 76811	Ob Us Detailed One Fetus 76811	Radiology	76811	CPT	2727329		Washington Regional Medical Center	outpatient	819	409.5	AmeriHealth Caritas North Carolina	NC Medicaid	287.96	147.59	614.25
Ob Us Detailed One Fetus 76811	Ob Us Detailed One Fetus 76811	Radiology	76811	CPT	2727329		Washington Regional Medical Center	outpatient	819	409.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	287.96	147.59	614.25
Ob Us Detailed One Fetus 76811	Ob Us Detailed One Fetus 76811	Radiology	76811	CPT	2727329		Washington Regional Medical Center	outpatient	819	409.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	287.96	147.59	614.25
Ob Us Detailed One Fetus 76811	Ob Us Detailed One Fetus 76811	Radiology	76811	CPT	2727329		Washington Regional Medical Center	outpatient	819	409.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	287.96	147.59	614.25
Ob Us Detailed One Fetus 76811	Ob Us Detailed One Fetus 76811	Radiology	76811	CPT	2727329		Washington Regional Medical Center	outpatient	819	409.5	Cigna	North Carolina PPO-PPA Direct	147.59	147.59	614.25
Ob Us Detailed One Fetus 76811	Ob Us Detailed One Fetus 76811	Radiology	76811	CPT	2727329		Washington Regional Medical Center	outpatient	819	409.5	Original Medicare	Traditional Medicare Fee-for-Service	384.93	147.59	614.25
Ophth UsDx B-ScanNonq A- 76512	Ophth UsDx B-ScanNonq A- 76512	Radiology	76512	CPT	2727315		Washington Regional Medical Center	outpatient	300	150	Self-Pay	Discounted Cash		72.46	225
Ophth UsDx B-ScanNonq A- 76512	Ophth UsDx B-ScanNonq A- 76512	Radiology	76512	CPT	2727315		Washington Regional Medical Center	outpatient	300	150	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	225	72.46	225
Ophth UsDx B-ScanNonq A- 76512	Ophth UsDx B-ScanNonq A- 76512	Radiology	76512	CPT	2727315		Washington Regional Medical Center	outpatient	300	150	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	132	72.46	225
Ophth UsDx B-ScanNonq A- 76512	Ophth UsDx B-ScanNonq A- 76512	Radiology	76512	CPT	2727315		Washington Regional Medical Center	outpatient	300	150	Humana	Medicare Advantage HMO/PPO/PFFS	141	72.46	225
Ophth UsDx B-ScanNonq A- 76512	Ophth UsDx B-ScanNonq A- 76512	Radiology	76512	CPT	2727315		Washington Regional Medical Center	outpatient	300	150	AmeriHealth Caritas North Carolina	NC Medicaid	105.48	72.46	225
Ophth UsDx B-ScanNonq A- 76512	Ophth UsDx B-ScanNonq A- 76512	Radiology	76512	CPT	2727315		Washington Regional Medical Center	outpatient	300	150	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	105.48	72.46	225
Ophth UsDx B-ScanNonq A- 76512	Ophth UsDx B-ScanNonq A- 76512	Radiology	76512	CPT	2727315		Washington Regional Medical Center	outpatient	300	150	WellCare of North Carolina	North Carolina Medicaid/CHIP	105.48	72.46	225
Ophth UsDx B-ScanNonq A- 76512	Ophth UsDx B-ScanNonq A- 76512	Radiology	76512	CPT	2727315		Washington Regional Medical Center	outpatient	300	150	Healthy Blue / Blue Cross NC	North Carolina Medicaid	105.48	72.46	225
Ophth UsDx B-ScanNonq A- 76512	Ophth UsDx B-ScanNonq A- 76512	Radiology	76512	CPT	2727315		Washington Regional Medical Center	outpatient	300	150	Cigna	North Carolina PPO-PPA Direct	72.46	72.46	225
Ophth UsDx B-ScanNonq A- 76512	Ophth UsDx B-ScanNonq A- 76512	Radiology	76512	CPT	2727315		Washington Regional Medical Center	outpatient	300	150	Original Medicare	Traditional Medicare Fee-for-Service	141	72.46	225
ORBIT BILATERAL RT/LT	ORBIT BILATERAL RT/LT	Radiology	70200	CPT	2001058		Washington Regional Medical Center	outpatient	385	192.5	Self-Pay	Discounted Cash		31.41	288.75
ORBIT BILATERAL RT/LT	ORBIT BILATERAL RT/LT	Radiology	70200	CPT	2001058		Washington Regional Medical Center	outpatient	385	192.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	288.75	31.41	288.75
ORBIT BILATERAL RT/LT	ORBIT BILATERAL RT/LT	Radiology	70200	CPT	2001058		Washington Regional Medical Center	outpatient	385	192.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	169.4	31.41	288.75
ORBIT BILATERAL RT/LT	ORBIT BILATERAL RT/LT	Radiology	70200	CPT	2001058		Washington Regional Medical Center	outpatient	385	192.5	Humana	Medicare Advantage HMO/PPO/PFFS	180.95	31.41	288.75
ORBIT BILATERAL RT/LT	ORBIT BILATERAL RT/LT	Radiology	70200	CPT	2001058		Washington Regional Medical Center	outpatient	385	192.5	AmeriHealth Caritas North Carolina	NC Medicaid	135.37	31.41	288.75
ORBIT BILATERAL RT/LT	ORBIT BILATERAL RT/LT	Radiology	70200	CPT	2001058		Washington Regional Medical Center	outpatient	385	192.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	135.37	31.41	288.75
ORBIT BILATERAL RT/LT	ORBIT BILATERAL RT/LT	Radiology	70200	CPT	2001058		Washington Regional Medical Center	outpatient	385	192.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	135.37	31.41	288.75
ORBIT BILATERAL RT/LT	ORBIT BILATERAL RT/LT	Radiology	70200	CPT	2001058		Washington Regional Medical Center	outpatient	385	192.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	135.37	31.41	288.75
ORBIT BILATERAL RT/LT	ORBIT BILATERAL RT/LT	Radiology	70200	CPT	2001058		Washington Regional Medical Center	outpatient	385	192.5	Cigna	North Carolina PPO-PPA Direct	31.41	31.41	288.75
ORBIT BILATERAL RT/LT	ORBIT BILATERAL RT/LT	Radiology	70200	CPT	2001058		Washington Regional Medical Center	outpatient	385	192.5	Original Medicare	Traditional Medicare Fee-for-Service	180.95	31.41	288.75
ORBITS FOR FB LOCATION	ORBITS FOR FB LOCATION	Radiology	70030	CPT	2001239		Washington Regional Medical Center	outpatient	300	150	Self-Pay	Discounted Cash		16.73	225
ORBITS FOR FB LOCATION	ORBITS FOR FB LOCATION	Radiology	70030	CPT	2001239		Washington Regional Medical Center	outpatient	300	150	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	225	16.73	225
ORBITS FOR FB LOCATION	ORBITS FOR FB LOCATION	Radiology	70030	CPT	2001239		Washington Regional Medical Center	outpatient	300	150	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	132	16.73	225
ORBITS FOR FB LOCATION	ORBITS FOR FB LOCATION	Radiology	70030	CPT	2001239		Washington Regional Medical Center	outpatient	300	150	Humana	Medicare Advantage HMO/PPO/PFFS	141	16.73	225
ORBITS FOR FB LOCATION	ORBITS FOR FB LOCATION	Radiology	70030	CPT	2001239		Washington Regional Medical Center	outpatient	300	150	AmeriHealth Caritas North Carolina	NC Medicaid	105.48	16.73	225
ORBITS FOR FB LOCATION	ORBITS FOR FB LOCATION	Radiology	70030	CPT	2001239		Washington Regional Medical Center	outpatient	300	150	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	105.48	16.73	225
ORBITS FOR FB LOCATION	ORBITS FOR FB LOCATION	Radiology	70030	CPT	2001239		Washington Regional Medical Center	outpatient	300	150	WellCare of North Carolina	North Carolina Medicaid/CHIP	105.48	16.73	225
ORBITS FOR FB LOCATION	ORBITS FOR FB LOCATION	Radiology	70030	CPT	2001239		Washington Regional Medical Center	outpatient	300	150	Healthy Blue / Blue Cross NC	North Carolina Medicaid	105.48	16.73	225
ORBITS FOR FB LOCATION	ORBITS FOR FB LOCATION	Radiology	70030	CPT	2001239		Washington Regional Medical Center	outpatient	300	150	Cigna	North Carolina PPO-PPA Direct	16.73	16.73	225
ORBITS FOR FB LOCATION	ORBITS FOR FB LOCATION	Radiology	70030	CPT	2001239		Washington Regional Medical Center	outpatient	300	150	Original Medicare	Traditional Medicare Fee-for-Service	141	16.73	225
PLACE PORT-A-CATH W/FLURO	PLACE PORT-A-CATH W/FLURO	Radiology	77001	CPT	2001176		Washington Regional Medical Center	outpatient	245	122.5	Self-Pay	Discounted Cash		64.37	183.75
PLACE PORT-A-CATH W/FLURO	PLACE PORT-A-CATH W/FLURO	Radiology	77001	CPT	2001176		Washington Regional Medical Center	outpatient	245	122.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	183.75	64.37	183.75
PLACE PORT-A-CATH W/FLURO	PLACE PORT-A-CATH W/FLURO	Radiology	77001	CPT	2001176		Washington Regional Medical Center	outpatient	245	122.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	107.8	64.37	183.75
PLACE PORT-A-CATH W/FLURO	PLACE PORT-A-CATH W/FLURO	Radiology	77001	CPT	2001176		Washington Regional Medical Center	outpatient	245	122.5	Humana	Medicare Advantage HMO/PPO/PFFS	115.15	64.37	183.75
PLACE PORT-A-CATH W/FLURO	PLACE PORT-A-CATH W/FLURO	Radiology	77001	CPT	2001176		Washington Regional Medical Center	outpatient	245	122.5	AmeriHealth Caritas North Carolina	NC Medicaid	86.14	64.37	183.75
PLACE PORT-A-CATH W/FLURO	PLACE PORT-A-CATH W/FLURO	Radiology	77001	CPT	2001176		Washington Regional Medical Center	outpatient	245	122.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	86.14	64.37	183.75
PLACE PORT-A-CATH W/FLURO	PLACE PORT-A-CATH W/FLURO	Radiology	77001	CPT	2001176		Washington Regional Medical Center	outpatient	245	122.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	86.14	64.37	183.75
PLACE PORT-A-CATH W/FLURO	PLACE PORT-A-CATH W/FLURO	Radiology	77001	CPT	2001176		Washington Regional Medical Center	outpatient	245	122.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	86.14	64.37	183.75
PLACE PORT-A-CATH W/FLURO	PLACE PORT-A-CATH W/FLURO	Radiology	77001	CPT	2001176		Washington Regional Medical Center	outpatient	245	122.5	Cigna	North Carolina PPO-PPA Direct	64.37	64.37	183.75
PLACE PORT-A-CATH W/FLURO	PLACE PORT-A-CATH W/FLURO	Radiology	77001	CPT	2001176		Washington Regional Medical Center	outpatient	245	122.5	Original Medicare	Traditional Medicare Fee-for-Service	115.15	64.37	183.75
RAD SMALL INTESTINE FT STUDY	RAD SMALL INTESTINE FT STUDY	Radiology	74248	CPT	2001042		Washington Regional Medical Center	outpatient	642	321	Self-Pay	Discounted Cash		51.29	481.5
RAD SMALL INTESTINE FT STUDY	RAD SMALL INTESTINE FT STUDY	Radiology	74248	CPT	2001042		Washington Regional Medical Center	outpatient	642	321	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	481.5	51.29	481.5
RAD SMALL INTESTINE FT STUDY	RAD SMALL INTESTINE FT STUDY	Radiology	74248	CPT	2001042		Washington Regional Medical Center	outpatient	642	321	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	282.48	51.29	481.5
RAD SMALL INTESTINE FT STUDY	RAD SMALL INTESTINE FT STUDY	Radiology	74248	CPT	2001042		Washington Regional Medical Center	outpatient	642	321	Humana	Medicare Advantage HMO/PPO/PFFS	301.74	51.29	481.5
RAD SMALL INTESTINE FT STUDY	RAD SMALL INTESTINE FT STUDY	Radiology	74248	CPT	2001042		Washington Regional Medical Center	outpatient	642	321	AmeriHealth Caritas North Carolina	NC Medicaid	225.73	51.29	481.5
RAD SMALL INTESTINE FT STUDY	RAD SMALL INTESTINE FT STUDY	Radiology	74248	CPT	2001042		Washington Regional Medical Center	outpatient	642	321	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	225.73	51.29	481.5
RAD SMALL INTESTINE FT STUDY	RAD SMALL INTESTINE FT STUDY	Radiology	74248	CPT	2001042		Washington Regional Medical Center	outpatient	642	321	WellCare of North Carolina	North Carolina Medicaid/CHIP	225.73	51.29	481.5
RAD SMALL INTESTINE FT STUDY	RAD SMALL INTESTINE FT STUDY	Radiology	74248	CPT	2001042		Washington Regional Medical Center	outpatient	642	321	Healthy Blue / Blue Cross NC	North Carolina Medicaid	225.73	51.29	481.5
RAD SMALL INTESTINE FT STUDY	RAD SMALL INTESTINE FT STUDY	Radiology	74248	CPT	2001042		Washington Regional Medical Center	outpatient	642	321	Cigna	North Carolina PPO-PPA Direct	51.29	51.29	481.5
RAD SMALL INTESTINE FT STUDY	RAD SMALL INTESTINE FT STUDY	Radiology	74248	CPT	2001042		Washington Regional Medical Center	outpatient	642	321	Original Medicare	Traditional Medicare Fee-for-Service	301.74	51.29	481.5
RIBS LT	RIBS LT	Radiology	71100	CPT	2001013		Washington Regional Medical Center	outpatient	275	137.5	Self-Pay	Discounted Cash		23.05	206.25
RIBS LT	RIBS LT	Radiology	71100	CPT	2001013		Washington Regional Medical Center	outpatient	275	137.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	206.25	23.05	206.25
RIBS LT	RIBS LT	Radiology	71100	CPT	2001013		Washington Regional Medical Center	outpatient	275	137.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	121	23.05	206.25
RIBS LT	RIBS LT	Radiology	71100	CPT	2001013		Washington Regional Medical Center	outpatient	275	137.5	Humana	Medicare Advantage HMO/PPO/PFFS	129.25	23.05	206.25
RIBS LT	RIBS LT	Radiology	71100	CPT	2001013		Washington Regional Medical Center	outpatient	275	137.5	AmeriHealth Caritas North Carolina	NC Medicaid	96.69	23.05	206.25
RIBS LT	RIBS LT	Radiology	71100	CPT	2001013		Washington Regional Medical Center	outpatient	275	137.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	96.69	23.05	206.25
RIBS LT	RIBS LT	Radiology	71100	CPT	2001013		Washington Regional Medical Center	outpatient	275	137.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	96.69	23.05	206.25
RIBS LT	RIBS LT	Radiology	71100	CPT	2001013		Washington Regional Medical Center	outpatient	275	137.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	96.69	23.05	206.25
RIBS LT	RIBS LT	Radiology	71100	CPT	2001013		Washington Regional Medical Center	outpatient	275	137.5	Cigna	North Carolina PPO-PPA Direct	23.05	23.05	206.25
RIBS LT	RIBS LT	Radiology	71100	CPT	2001013		Washington Regional Medical Center	outpatient	275	137.5	Original Medicare	Traditional Medicare Fee-for-Service	129.25	23.05	206.25
RIBS RT	RIBS RT	Radiology	71100	CPT	2001063		Washington Regional Medical Center	outpatient	275	137.5	Self-Pay	Discounted Cash		23.05	206.25
RIBS RT	RIBS RT	Radiology	71100	CPT	2001063		Washington Regional Medical Center	outpatient	275	137.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	206.25	23.05	206.25
RIBS RT	RIBS RT	Radiology	71100	CPT	2001063		Washington Regional Medical Center	outpatient	275	137.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	121	23.05	206.25
RIBS RT	RIBS RT	Radiology	71100	CPT	2001063		Washington Regional Medical Center	outpatient	275	137.5	Humana	Medicare Advantage HMO/PPO/PFFS	129.25	23.05	206.25
RIBS RT	RIBS RT	Radiology	71100	CPT	2001063		Washington Regional Medical Center	outpatient	275	137.5	AmeriHealth Caritas North Carolina	NC Medicaid	96.69	23.05	206.25
RIBS RT	RIBS RT	Radiology	71100	CPT	2001063		Washington Regional Medical Center	outpatient	275	137.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	96.69	23.05	206.25
RIBS RT	RIBS RT	Radiology	71100	CPT	2001063		Washington Regional Medical Center	outpatient	275	137.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	96.69	23.05	206.25
RIBS RT	RIBS RT	Radiology	71100	CPT	2001063		Washington Regional Medical Center	outpatient	275	137.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	96.69	23.05	206.25
RIBS RT	RIBS RT	Radiology	71100	CPT	2001063		Washington Regional Medical Center	outpatient	275	137.5	Cigna	North Carolina PPO-PPA Direct	23.05	23.05	206.25
RIBS RT	RIBS RT	Radiology	71100	CPT	2001063		Washington Regional Medical Center	outpatient	275	137.5	Original Medicare	Traditional Medicare Fee-for-Service	129.25	23.05	206.25
RIBS W/PA CHEST BIL	RIBS W/PA CHEST BIL	Radiology	71111	CPT	2001151		Washington Regional Medical Center	outpatient	749	374.5	Self-Pay	Discounted Cash		35.92	561.75
RIBS W/PA CHEST BIL	RIBS W/PA CHEST BIL	Radiology	71111	CPT	2001151		Washington Regional Medical Center	outpatient	749	374.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	561.75	35.92	561.75
RIBS W/PA CHEST BIL	RIBS W/PA CHEST BIL	Radiology	71111	CPT	2001151		Washington Regional Medical Center	outpatient	749	374.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	329.56	35.92	561.75
RIBS W/PA CHEST BIL	RIBS W/PA CHEST BIL	Radiology	71111	CPT	2001151		Washington Regional Medical Center	outpatient	749	374.5	Humana	Medicare Advantage HMO/PPO/PFFS	352.03	35.92	561.75
RIBS W/PA CHEST BIL	RIBS W/PA CHEST BIL	Radiology	71111	CPT	2001151		Washington Regional Medical Center	outpatient	749	374.5	AmeriHealth Caritas North Carolina	NC Medicaid	263.35	35.92	561.75
RIBS W/PA CHEST BIL	RIBS W/PA CHEST BIL	Radiology	71111	CPT	2001151		Washington Regional Medical Center	outpatient	749	374.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	263.35	35.92	561.75
RIBS W/PA CHEST BIL	RIBS W/PA CHEST BIL	Radiology	71111	CPT	2001151		Washington Regional Medical Center	outpatient	749	374.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	263.35	35.92	561.75
RIBS W/PA CHEST BIL	RIBS W/PA CHEST BIL	Radiology	71111	CPT	2001151		Washington Regional Medical Center	outpatient	749	374.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	263.35	35.92	561.75
RIBS W/PA CHEST BIL	RIBS W/PA CHEST BIL	Radiology	71111	CPT	2001151		Washington Regional Medical Center	outpatient	749	374.5	Cigna	North Carolina PPO-PPA Direct	35.92	35.92	561.75
RIBS W/PA CHEST BIL	RIBS W/PA CHEST BIL	Radiology	71111	CPT	2001151		Washington Regional Medical Center	outpatient	749	374.5	Original Medicare	Traditional Medicare Fee-for-Service	352.03	35.92	561.75
RP LOCLZJ TUM PLNR 1 AREA SIN	RP LOCLZJ TUM PLNR 1 AREA SIN	Radiology	78800	CPT	2001253		Washington Regional Medical Center	outpatient	2083	1041.5	Self-Pay	Discounted Cash		135.91	1562.25
RP LOCLZJ TUM PLNR 1 AREA SIN	RP LOCLZJ TUM PLNR 1 AREA SIN	Radiology	78800	CPT	2001253		Washington Regional Medical Center	outpatient	2083	1041.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1562.25	135.91	1562.25
RP LOCLZJ TUM PLNR 1 AREA SIN	RP LOCLZJ TUM PLNR 1 AREA SIN	Radiology	78800	CPT	2001253		Washington Regional Medical Center	outpatient	2083	1041.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	916.52	135.91	1562.25
RP LOCLZJ TUM PLNR 1 AREA SIN	RP LOCLZJ TUM PLNR 1 AREA SIN	Radiology	78800	CPT	2001253		Washington Regional Medical Center	outpatient	2083	1041.5	Humana	Medicare Advantage HMO/PPO/PFFS	979.01	135.91	1562.25
RP LOCLZJ TUM PLNR 1 AREA SIN	RP LOCLZJ TUM PLNR 1 AREA SIN	Radiology	78800	CPT	2001253		Washington Regional Medical Center	outpatient	2083	1041.5	AmeriHealth Caritas North Carolina	NC Medicaid	732.38	135.91	1562.25
RP LOCLZJ TUM PLNR 1 AREA SIN	RP LOCLZJ TUM PLNR 1 AREA SIN	Radiology	78800	CPT	2001253		Washington Regional Medical Center	outpatient	2083	1041.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	732.38	135.91	1562.25
RP LOCLZJ TUM PLNR 1 AREA SIN	RP LOCLZJ TUM PLNR 1 AREA SIN	Radiology	78800	CPT	2001253		Washington Regional Medical Center	outpatient	2083	1041.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	732.38	135.91	1562.25
RP LOCLZJ TUM PLNR 1 AREA SIN	RP LOCLZJ TUM PLNR 1 AREA SIN	Radiology	78800	CPT	2001253		Washington Regional Medical Center	outpatient	2083	1041.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	732.38	135.91	1562.25
RP LOCLZJ TUM PLNR 1 AREA SIN	RP LOCLZJ TUM PLNR 1 AREA SIN	Radiology	78800	CPT	2001253		Washington Regional Medical Center	outpatient	2083	1041.5	Cigna	North Carolina PPO-PPA Direct	135.91	135.91	1562.25
RP LOCLZJ TUM PLNR 1 AREA SIN	RP LOCLZJ TUM PLNR 1 AREA SIN	Radiology	78800	CPT	2001253		Washington Regional Medical Center	outpatient	2083	1041.5	Original Medicare	Traditional Medicare Fee-for-Service	979.01	135.91	1562.25
RP LOCLZJ TUM SPECT 1 AREA	RP LOCLZJ TUM SPECT 1 AREA	Radiology	78803	CPT	2001256		Washington Regional Medical Center	outpatient	2985	1492.5	Self-Pay	Discounted Cash		261.91	2238.75
RP LOCLZJ TUM SPECT 1 AREA	RP LOCLZJ TUM SPECT 1 AREA	Radiology	78803	CPT	2001256		Washington Regional Medical Center	outpatient	2985	1492.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	2238.75	261.91	2238.75
RP LOCLZJ TUM SPECT 1 AREA	RP LOCLZJ TUM SPECT 1 AREA	Radiology	78803	CPT	2001256		Washington Regional Medical Center	outpatient	2985	1492.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	1313.4	261.91	2238.75
RP LOCLZJ TUM SPECT 1 AREA	RP LOCLZJ TUM SPECT 1 AREA	Radiology	78803	CPT	2001256		Washington Regional Medical Center	outpatient	2985	1492.5	Humana	Medicare Advantage HMO/PPO/PFFS	1402.95	261.91	2238.75
RP LOCLZJ TUM SPECT 1 AREA	RP LOCLZJ TUM SPECT 1 AREA	Radiology	78803	CPT	2001256		Washington Regional Medical Center	outpatient	2985	1492.5	AmeriHealth Caritas North Carolina	NC Medicaid	1049.53	261.91	2238.75
RP LOCLZJ TUM SPECT 1 AREA	RP LOCLZJ TUM SPECT 1 AREA	Radiology	78803	CPT	2001256		Washington Regional Medical Center	outpatient	2985	1492.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	1049.53	261.91	2238.75
RP LOCLZJ TUM SPECT 1 AREA	RP LOCLZJ TUM SPECT 1 AREA	Radiology	78803	CPT	2001256		Washington Regional Medical Center	outpatient	2985	1492.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	1049.53	261.91	2238.75
RP LOCLZJ TUM SPECT 1 AREA	RP LOCLZJ TUM SPECT 1 AREA	Radiology	78803	CPT	2001256		Washington Regional Medical Center	outpatient	2985	1492.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	1049.53	261.91	2238.75
RP LOCLZJ TUM SPECT 1 AREA	RP LOCLZJ TUM SPECT 1 AREA	Radiology	78803	CPT	2001256		Washington Regional Medical Center	outpatient	2985	1492.5	Cigna	North Carolina PPO-PPA Direct	261.91	261.91	2238.75
RP LOCLZJ TUM SPECT 1 AREA	RP LOCLZJ TUM SPECT 1 AREA	Radiology	78803	CPT	2001256		Washington Regional Medical Center	outpatient	2985	1492.5	Original Medicare	Traditional Medicare Fee-for-Service	1402.95	261.91	2238.75
RP LOCLZJ TUM SPECT CT 2AREA	RP LOCLZJ TUM SPECT CT 2AREA	Radiology	78832	CPT	2001259		Washington Regional Medical Center	outpatient	5696	2848	Self-Pay	Discounted Cash		908.19	4272
RP LOCLZJ TUM SPECT CT 2AREA	RP LOCLZJ TUM SPECT CT 2AREA	Radiology	78832	CPT	2001259		Washington Regional Medical Center	outpatient	5696	2848	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	4272	908.19	4272
RP LOCLZJ TUM SPECT CT 2AREA	RP LOCLZJ TUM SPECT CT 2AREA	Radiology	78832	CPT	2001259		Washington Regional Medical Center	outpatient	5696	2848	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	2506.24	908.19	4272
RP LOCLZJ TUM SPECT CT 2AREA	RP LOCLZJ TUM SPECT CT 2AREA	Radiology	78832	CPT	2001259		Washington Regional Medical Center	outpatient	5696	2848	Humana	Medicare Advantage HMO/PPO/PFFS	2677.12	908.19	4272
RP LOCLZJ TUM SPECT CT 2AREA	RP LOCLZJ TUM SPECT CT 2AREA	Radiology	78832	CPT	2001259		Washington Regional Medical Center	outpatient	5696	2848	AmeriHealth Caritas North Carolina	NC Medicaid	2002.71	908.19	4272
RP LOCLZJ TUM SPECT CT 2AREA	RP LOCLZJ TUM SPECT CT 2AREA	Radiology	78832	CPT	2001259		Washington Regional Medical Center	outpatient	5696	2848	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	2002.71	908.19	4272
RP LOCLZJ TUM SPECT CT 2AREA	RP LOCLZJ TUM SPECT CT 2AREA	Radiology	78832	CPT	2001259		Washington Regional Medical Center	outpatient	5696	2848	WellCare of North Carolina	North Carolina Medicaid/CHIP	2002.71	908.19	4272
RP LOCLZJ TUM SPECT CT 2AREA	RP LOCLZJ TUM SPECT CT 2AREA	Radiology	78832	CPT	2001259		Washington Regional Medical Center	outpatient	5696	2848	Healthy Blue / Blue Cross NC	North Carolina Medicaid	2002.71	908.19	4272
RP LOCLZJ TUM SPECT CT 2AREA	RP LOCLZJ TUM SPECT CT 2AREA	Radiology	78832	CPT	2001259		Washington Regional Medical Center	outpatient	5696	2848	Cigna	North Carolina PPO-PPA Direct	908.19	908.19	4272
RP LOCLZJ TUM SPECT CT 2AREA	RP LOCLZJ TUM SPECT CT 2AREA	Radiology	78832	CPT	2001259		Washington Regional Medical Center	outpatient	5696	2848	Original Medicare	Traditional Medicare Fee-for-Service	2677.12	908.19	4272
SACRUM & COCCYX 2T	SACRUM & COCCYX 2T	Radiology	72220	CPT	2001066		Washington Regional Medical Center	outpatient	281	140.5	Self-Pay	Discounted Cash		23.05	210.75
SACRUM & COCCYX 2T	SACRUM & COCCYX 2T	Radiology	72220	CPT	2001066		Washington Regional Medical Center	outpatient	281	140.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	210.75	23.05	210.75
SACRUM & COCCYX 2T	SACRUM & COCCYX 2T	Radiology	72220	CPT	2001066		Washington Regional Medical Center	outpatient	281	140.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	123.64	23.05	210.75
SACRUM & COCCYX 2T	SACRUM & COCCYX 2T	Radiology	72220	CPT	2001066		Washington Regional Medical Center	outpatient	281	140.5	Humana	Medicare Advantage HMO/PPO/PFFS	132.07	23.05	210.75
SACRUM & COCCYX 2T	SACRUM & COCCYX 2T	Radiology	72220	CPT	2001066		Washington Regional Medical Center	outpatient	281	140.5	AmeriHealth Caritas North Carolina	NC Medicaid	98.8	23.05	210.75
SACRUM & COCCYX 2T	SACRUM & COCCYX 2T	Radiology	72220	CPT	2001066		Washington Regional Medical Center	outpatient	281	140.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	98.8	23.05	210.75
SACRUM & COCCYX 2T	SACRUM & COCCYX 2T	Radiology	72220	CPT	2001066		Washington Regional Medical Center	outpatient	281	140.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	98.8	23.05	210.75
SACRUM & COCCYX 2T	SACRUM & COCCYX 2T	Radiology	72220	CPT	2001066		Washington Regional Medical Center	outpatient	281	140.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	98.8	23.05	210.75
SACRUM & COCCYX 2T	SACRUM & COCCYX 2T	Radiology	72220	CPT	2001066		Washington Regional Medical Center	outpatient	281	140.5	Cigna	North Carolina PPO-PPA Direct	23.05	23.05	210.75
SACRUM & COCCYX 2T	SACRUM & COCCYX 2T	Radiology	72220	CPT	2001066		Washington Regional Medical Center	outpatient	281	140.5	Original Medicare	Traditional Medicare Fee-for-Service	132.07	23.05	210.75
SHOULDER, 1 VIEW LT	SHOULDER, 1 VIEW LT	Radiology	73020	CPT	2001029		Washington Regional Medical Center	outpatient	275	137.5	Self-Pay	Discounted Cash		18.66	206.25
SHOULDER, 1 VIEW LT	SHOULDER, 1 VIEW LT	Radiology	73020	CPT	2001029		Washington Regional Medical Center	outpatient	275	137.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	206.25	18.66	206.25
SHOULDER, 1 VIEW LT	SHOULDER, 1 VIEW LT	Radiology	73020	CPT	2001029		Washington Regional Medical Center	outpatient	275	137.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	121	18.66	206.25
SHOULDER, 1 VIEW LT	SHOULDER, 1 VIEW LT	Radiology	73020	CPT	2001029		Washington Regional Medical Center	outpatient	275	137.5	Humana	Medicare Advantage HMO/PPO/PFFS	129.25	18.66	206.25
SHOULDER, 1 VIEW LT	SHOULDER, 1 VIEW LT	Radiology	73020	CPT	2001029		Washington Regional Medical Center	outpatient	275	137.5	AmeriHealth Caritas North Carolina	NC Medicaid	96.69	18.66	206.25
SHOULDER, 1 VIEW LT	SHOULDER, 1 VIEW LT	Radiology	73020	CPT	2001029		Washington Regional Medical Center	outpatient	275	137.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	96.69	18.66	206.25
SHOULDER, 1 VIEW LT	SHOULDER, 1 VIEW LT	Radiology	73020	CPT	2001029		Washington Regional Medical Center	outpatient	275	137.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	96.69	18.66	206.25
SHOULDER, 1 VIEW LT	SHOULDER, 1 VIEW LT	Radiology	73020	CPT	2001029		Washington Regional Medical Center	outpatient	275	137.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	96.69	18.66	206.25
SHOULDER, 1 VIEW LT	SHOULDER, 1 VIEW LT	Radiology	73020	CPT	2001029		Washington Regional Medical Center	outpatient	275	137.5	Cigna	North Carolina PPO-PPA Direct	18.66	18.66	206.25
SHOULDER, 1 VIEW LT	SHOULDER, 1 VIEW LT	Radiology	73020	CPT	2001029		Washington Regional Medical Center	outpatient	275	137.5	Original Medicare	Traditional Medicare Fee-for-Service	129.25	18.66	206.25
SHOULDER, 1 VIEW RT	SHOULDER, 1 VIEW RT	Radiology	73020	CPT	2001030		Washington Regional Medical Center	outpatient	275	137.5	Self-Pay	Discounted Cash		18.66	206.25
SHOULDER, 1 VIEW RT	SHOULDER, 1 VIEW RT	Radiology	73020	CPT	2001030		Washington Regional Medical Center	outpatient	275	137.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	206.25	18.66	206.25
SHOULDER, 1 VIEW RT	SHOULDER, 1 VIEW RT	Radiology	73020	CPT	2001030		Washington Regional Medical Center	outpatient	275	137.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	121	18.66	206.25
SHOULDER, 1 VIEW RT	SHOULDER, 1 VIEW RT	Radiology	73020	CPT	2001030		Washington Regional Medical Center	outpatient	275	137.5	Humana	Medicare Advantage HMO/PPO/PFFS	129.25	18.66	206.25
SHOULDER, 1 VIEW RT	SHOULDER, 1 VIEW RT	Radiology	73020	CPT	2001030		Washington Regional Medical Center	outpatient	275	137.5	AmeriHealth Caritas North Carolina	NC Medicaid	96.69	18.66	206.25
SHOULDER, 1 VIEW RT	SHOULDER, 1 VIEW RT	Radiology	73020	CPT	2001030		Washington Regional Medical Center	outpatient	275	137.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	96.69	18.66	206.25
SHOULDER, 1 VIEW RT	SHOULDER, 1 VIEW RT	Radiology	73020	CPT	2001030		Washington Regional Medical Center	outpatient	275	137.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	96.69	18.66	206.25
SHOULDER, 1 VIEW RT	SHOULDER, 1 VIEW RT	Radiology	73020	CPT	2001030		Washington Regional Medical Center	outpatient	275	137.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	96.69	18.66	206.25
SHOULDER, 1 VIEW RT	SHOULDER, 1 VIEW RT	Radiology	73020	CPT	2001030		Washington Regional Medical Center	outpatient	275	137.5	Cigna	North Carolina PPO-PPA Direct	18.66	18.66	206.25
SHOULDER, 1 VIEW RT	SHOULDER, 1 VIEW RT	Radiology	73020	CPT	2001030		Washington Regional Medical Center	outpatient	275	137.5	Original Medicare	Traditional Medicare Fee-for-Service	129.25	18.66	206.25
SINUS TRACT	SINUS TRACT	Radiology	76080	CPT	2001156		Washington Regional Medical Center	outpatient	295	147.5	Self-Pay	Discounted Cash		42.09	221.25
SINUS TRACT	SINUS TRACT	Radiology	76080	CPT	2001156		Washington Regional Medical Center	outpatient	295	147.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	221.25	42.09	221.25
SINUS TRACT	SINUS TRACT	Radiology	76080	CPT	2001156		Washington Regional Medical Center	outpatient	295	147.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	129.8	42.09	221.25
SINUS TRACT	SINUS TRACT	Radiology	76080	CPT	2001156		Washington Regional Medical Center	outpatient	295	147.5	Humana	Medicare Advantage HMO/PPO/PFFS	138.65	42.09	221.25
SINUS TRACT	SINUS TRACT	Radiology	76080	CPT	2001156		Washington Regional Medical Center	outpatient	295	147.5	AmeriHealth Caritas North Carolina	NC Medicaid	103.72	42.09	221.25
SINUS TRACT	SINUS TRACT	Radiology	76080	CPT	2001156		Washington Regional Medical Center	outpatient	295	147.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	103.72	42.09	221.25
SINUS TRACT	SINUS TRACT	Radiology	76080	CPT	2001156		Washington Regional Medical Center	outpatient	295	147.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	103.72	42.09	221.25
SINUS TRACT	SINUS TRACT	Radiology	76080	CPT	2001156		Washington Regional Medical Center	outpatient	295	147.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	103.72	42.09	221.25
SINUS TRACT	SINUS TRACT	Radiology	76080	CPT	2001156		Washington Regional Medical Center	outpatient	295	147.5	Cigna	North Carolina PPO-PPA Direct	42.09	42.09	221.25
SINUS TRACT	SINUS TRACT	Radiology	76080	CPT	2001156		Washington Regional Medical Center	outpatient	295	147.5	Original Medicare	Traditional Medicare Fee-for-Service	138.65	42.09	221.25
SKULL AP & LAT	SKULL AP & LAT	Radiology	70250	CPT	2001073		Washington Regional Medical Center	outpatient	256	128	Self-Pay	Discounted Cash		24.97	192
SKULL AP & LAT	SKULL AP & LAT	Radiology	70250	CPT	2001073		Washington Regional Medical Center	outpatient	256	128	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	192	24.97	192
SKULL AP & LAT	SKULL AP & LAT	Radiology	70250	CPT	2001073		Washington Regional Medical Center	outpatient	256	128	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	112.64	24.97	192
SKULL AP & LAT	SKULL AP & LAT	Radiology	70250	CPT	2001073		Washington Regional Medical Center	outpatient	256	128	Humana	Medicare Advantage HMO/PPO/PFFS	120.32	24.97	192
SKULL AP & LAT	SKULL AP & LAT	Radiology	70250	CPT	2001073		Washington Regional Medical Center	outpatient	256	128	AmeriHealth Caritas North Carolina	NC Medicaid	90.01	24.97	192
SKULL AP & LAT	SKULL AP & LAT	Radiology	70250	CPT	2001073		Washington Regional Medical Center	outpatient	256	128	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	90.01	24.97	192
SKULL AP & LAT	SKULL AP & LAT	Radiology	70250	CPT	2001073		Washington Regional Medical Center	outpatient	256	128	WellCare of North Carolina	North Carolina Medicaid/CHIP	90.01	24.97	192
SKULL AP & LAT	SKULL AP & LAT	Radiology	70250	CPT	2001073		Washington Regional Medical Center	outpatient	256	128	Healthy Blue / Blue Cross NC	North Carolina Medicaid	90.01	24.97	192
SKULL AP & LAT	SKULL AP & LAT	Radiology	70250	CPT	2001073		Washington Regional Medical Center	outpatient	256	128	Cigna	North Carolina PPO-PPA Direct	24.97	24.97	192
SKULL AP & LAT	SKULL AP & LAT	Radiology	70250	CPT	2001073		Washington Regional Medical Center	outpatient	256	128	Original Medicare	Traditional Medicare Fee-for-Service	120.32	24.97	192
SPINE CERV 2-3 VIEWS	SPINE CERV 2-3 VIEWS	Radiology	72040	CPT	2001075		Washington Regional Medical Center	outpatient	328	164	Self-Pay	Discounted Cash		24.2	246
SPINE CERV 2-3 VIEWS	SPINE CERV 2-3 VIEWS	Radiology	72040	CPT	2001075		Washington Regional Medical Center	outpatient	328	164	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	246	24.2	246
SPINE CERV 2-3 VIEWS	SPINE CERV 2-3 VIEWS	Radiology	72040	CPT	2001075		Washington Regional Medical Center	outpatient	328	164	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	144.32	24.2	246
SPINE CERV 2-3 VIEWS	SPINE CERV 2-3 VIEWS	Radiology	72040	CPT	2001075		Washington Regional Medical Center	outpatient	328	164	Humana	Medicare Advantage HMO/PPO/PFFS	154.16	24.2	246
SPINE CERV 2-3 VIEWS	SPINE CERV 2-3 VIEWS	Radiology	72040	CPT	2001075		Washington Regional Medical Center	outpatient	328	164	AmeriHealth Caritas North Carolina	NC Medicaid	115.32	24.2	246
SPINE CERV 2-3 VIEWS	SPINE CERV 2-3 VIEWS	Radiology	72040	CPT	2001075		Washington Regional Medical Center	outpatient	328	164	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	115.32	24.2	246
SPINE CERV 2-3 VIEWS	SPINE CERV 2-3 VIEWS	Radiology	72040	CPT	2001075		Washington Regional Medical Center	outpatient	328	164	WellCare of North Carolina	North Carolina Medicaid/CHIP	115.32	24.2	246
SPINE CERV 2-3 VIEWS	SPINE CERV 2-3 VIEWS	Radiology	72040	CPT	2001075		Washington Regional Medical Center	outpatient	328	164	Healthy Blue / Blue Cross NC	North Carolina Medicaid	115.32	24.2	246
SPINE CERV 2-3 VIEWS	SPINE CERV 2-3 VIEWS	Radiology	72040	CPT	2001075		Washington Regional Medical Center	outpatient	328	164	Cigna	North Carolina PPO-PPA Direct	24.2	24.2	246
SPINE CERV 2-3 VIEWS	SPINE CERV 2-3 VIEWS	Radiology	72040	CPT	2001075		Washington Regional Medical Center	outpatient	328	164	Original Medicare	Traditional Medicare Fee-for-Service	154.16	24.2	246
SPINE LUMBAR 2 OR 3 VIEWS	SPINE LUMBAR 2 OR 3 VIEWS	Radiology	72100	CPT	2001077		Washington Regional Medical Center	outpatient	398	199	Self-Pay	Discounted Cash		26.9	298.5
SPINE LUMBAR 2 OR 3 VIEWS	SPINE LUMBAR 2 OR 3 VIEWS	Radiology	72100	CPT	2001077		Washington Regional Medical Center	outpatient	398	199	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	298.5	26.9	298.5
SPINE LUMBAR 2 OR 3 VIEWS	SPINE LUMBAR 2 OR 3 VIEWS	Radiology	72100	CPT	2001077		Washington Regional Medical Center	outpatient	398	199	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	175.12	26.9	298.5
SPINE LUMBAR 2 OR 3 VIEWS	SPINE LUMBAR 2 OR 3 VIEWS	Radiology	72100	CPT	2001077		Washington Regional Medical Center	outpatient	398	199	Humana	Medicare Advantage HMO/PPO/PFFS	187.06	26.9	298.5
SPINE LUMBAR 2 OR 3 VIEWS	SPINE LUMBAR 2 OR 3 VIEWS	Radiology	72100	CPT	2001077		Washington Regional Medical Center	outpatient	398	199	AmeriHealth Caritas North Carolina	NC Medicaid	139.94	26.9	298.5
SPINE LUMBAR 2 OR 3 VIEWS	SPINE LUMBAR 2 OR 3 VIEWS	Radiology	72100	CPT	2001077		Washington Regional Medical Center	outpatient	398	199	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	139.94	26.9	298.5
SPINE LUMBAR 2 OR 3 VIEWS	SPINE LUMBAR 2 OR 3 VIEWS	Radiology	72100	CPT	2001077		Washington Regional Medical Center	outpatient	398	199	WellCare of North Carolina	North Carolina Medicaid/CHIP	139.94	26.9	298.5
SPINE LUMBAR 2 OR 3 VIEWS	SPINE LUMBAR 2 OR 3 VIEWS	Radiology	72100	CPT	2001077		Washington Regional Medical Center	outpatient	398	199	Healthy Blue / Blue Cross NC	North Carolina Medicaid	139.94	26.9	298.5
SPINE LUMBAR 2 OR 3 VIEWS	SPINE LUMBAR 2 OR 3 VIEWS	Radiology	72100	CPT	2001077		Washington Regional Medical Center	outpatient	398	199	Cigna	North Carolina PPO-PPA Direct	26.9	26.9	298.5
SPINE LUMBAR 2 OR 3 VIEWS	SPINE LUMBAR 2 OR 3 VIEWS	Radiology	72100	CPT	2001077		Washington Regional Medical Center	outpatient	398	199	Original Medicare	Traditional Medicare Fee-for-Service	187.06	26.9	298.5
SPINE THORACIC 2 VIEWS	SPINE THORACIC 2 VIEWS	Radiology	72070	CPT	2000075		Washington Regional Medical Center	outpatient	333.57	166.79	Self-Pay	Discounted Cash		26.13	250.18
SPINE THORACIC 2 VIEWS	SPINE THORACIC 2 VIEWS	Radiology	72070	CPT	2000075		Washington Regional Medical Center	outpatient	333.57	166.79	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	250.18	26.13	250.18
SPINE THORACIC 2 VIEWS	SPINE THORACIC 2 VIEWS	Radiology	72070	CPT	2000075		Washington Regional Medical Center	outpatient	333.57	166.79	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	146.77	26.13	250.18
SPINE THORACIC 2 VIEWS	SPINE THORACIC 2 VIEWS	Radiology	72070	CPT	2000075		Washington Regional Medical Center	outpatient	333.57	166.79	Humana	Medicare Advantage HMO/PPO/PFFS	156.78	26.13	250.18
SPINE THORACIC 2 VIEWS	SPINE THORACIC 2 VIEWS	Radiology	72070	CPT	2000075		Washington Regional Medical Center	outpatient	333.57	166.79	AmeriHealth Caritas North Carolina	NC Medicaid	117.28	26.13	250.18
SPINE THORACIC 2 VIEWS	SPINE THORACIC 2 VIEWS	Radiology	72070	CPT	2000075		Washington Regional Medical Center	outpatient	333.57	166.79	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	117.28	26.13	250.18
SPINE THORACIC 2 VIEWS	SPINE THORACIC 2 VIEWS	Radiology	72070	CPT	2000075		Washington Regional Medical Center	outpatient	333.57	166.79	WellCare of North Carolina	North Carolina Medicaid/CHIP	117.28	26.13	250.18
SPINE THORACIC 2 VIEWS	SPINE THORACIC 2 VIEWS	Radiology	72070	CPT	2000075		Washington Regional Medical Center	outpatient	333.57	166.79	Healthy Blue / Blue Cross NC	North Carolina Medicaid	117.28	26.13	250.18
SPINE THORACIC 2 VIEWS	SPINE THORACIC 2 VIEWS	Radiology	72070	CPT	2000075		Washington Regional Medical Center	outpatient	333.57	166.79	Cigna	North Carolina PPO-PPA Direct	26.13	26.13	250.18
SPINE THORACIC 2 VIEWS	SPINE THORACIC 2 VIEWS	Radiology	72070	CPT	2000075		Washington Regional Medical Center	outpatient	333.57	166.79	Original Medicare	Traditional Medicare Fee-for-Service	156.78	26.13	250.18
Ultrasound of abdomen	US ABD COMPLETE	Radiology	76700	CPT	2101021		Washington Regional Medical Center	outpatient	1088	544	Self-Pay	Discounted Cash		78.9	816
Ultrasound of abdomen	US ABD COMPLETE	Radiology	76700	CPT	2101021		Washington Regional Medical Center	outpatient	1088	544	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	816	78.9	816
Ultrasound of abdomen	US ABD COMPLETE	Radiology	76700	CPT	2101021		Washington Regional Medical Center	outpatient	1088	544	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	478.72	78.9	816
Ultrasound of abdomen	US ABD COMPLETE	Radiology	76700	CPT	2101021		Washington Regional Medical Center	outpatient	1088	544	Humana	Medicare Advantage HMO/PPO/PFFS	511.36	78.9	816
Ultrasound of abdomen	US ABD COMPLETE	Radiology	76700	CPT	2101021		Washington Regional Medical Center	outpatient	1088	544	AmeriHealth Caritas North Carolina	NC Medicaid	382.54	78.9	816
Ultrasound of abdomen	US ABD COMPLETE	Radiology	76700	CPT	2101021		Washington Regional Medical Center	outpatient	1088	544	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	382.54	78.9	816
Ultrasound of abdomen	US ABD COMPLETE	Radiology	76700	CPT	2101021		Washington Regional Medical Center	outpatient	1088	544	WellCare of North Carolina	North Carolina Medicaid/CHIP	382.54	78.9	816
Ultrasound of abdomen	US ABD COMPLETE	Radiology	76700	CPT	2101021		Washington Regional Medical Center	outpatient	1088	544	Healthy Blue / Blue Cross NC	North Carolina Medicaid	382.54	78.9	816
Ultrasound of abdomen	US ABD COMPLETE	Radiology	76700	CPT	2101021		Washington Regional Medical Center	outpatient	1088	544	Cigna	North Carolina PPO-PPA Direct	78.9	78.9	816
Ultrasound of abdomen	US ABD COMPLETE	Radiology	76700	CPT	2101021		Washington Regional Medical Center	outpatient	1088	544	Original Medicare	Traditional Medicare Fee-for-Service	511.36	78.9	816
Ultrasound pelvis through vagina	US TRANSVAGINAL	Radiology	76830	CPT	2101055		Washington Regional Medical Center	outpatient	954	477	Self-Pay	Discounted Cash		61.28	715.5
Ultrasound pelvis through vagina	US TRANSVAGINAL	Radiology	76830	CPT	2101055		Washington Regional Medical Center	outpatient	954	477	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	715.5	61.28	715.5
Ultrasound pelvis through vagina	US TRANSVAGINAL	Radiology	76830	CPT	2101055		Washington Regional Medical Center	outpatient	954	477	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	419.76	61.28	715.5
Ultrasound pelvis through vagina	US TRANSVAGINAL	Radiology	76830	CPT	2101055		Washington Regional Medical Center	outpatient	954	477	Humana	Medicare Advantage HMO/PPO/PFFS	448.38	61.28	715.5
Ultrasound pelvis through vagina	US TRANSVAGINAL	Radiology	76830	CPT	2101055		Washington Regional Medical Center	outpatient	954	477	AmeriHealth Caritas North Carolina	NC Medicaid	335.43	61.28	715.5
Ultrasound pelvis through vagina	US TRANSVAGINAL	Radiology	76830	CPT	2101055		Washington Regional Medical Center	outpatient	954	477	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	335.43	61.28	715.5
Ultrasound pelvis through vagina	US TRANSVAGINAL	Radiology	76830	CPT	2101055		Washington Regional Medical Center	outpatient	954	477	WellCare of North Carolina	North Carolina Medicaid/CHIP	335.43	61.28	715.5
Ultrasound pelvis through vagina	US TRANSVAGINAL	Radiology	76830	CPT	2101055		Washington Regional Medical Center	outpatient	954	477	Healthy Blue / Blue Cross NC	North Carolina Medicaid	335.43	61.28	715.5
Ultrasound pelvis through vagina	US TRANSVAGINAL	Radiology	76830	CPT	2101055		Washington Regional Medical Center	outpatient	954	477	Cigna	North Carolina PPO-PPA Direct	61.28	61.28	715.5
Ultrasound pelvis through vagina	US TRANSVAGINAL	Radiology	76830	CPT	2101055		Washington Regional Medical Center	outpatient	954	477	Original Medicare	Traditional Medicare Fee-for-Service	448.38	61.28	715.5
UP EXTM, INFANT 2V LT	UP EXTM, INFANT 2V LT	Radiology	73092	CPT	2001025		Washington Regional Medical Center	outpatient	174	87	Self-Pay	Discounted Cash		19.43	130.5
UP EXTM, INFANT 2V LT	UP EXTM, INFANT 2V LT	Radiology	73092	CPT	2001025		Washington Regional Medical Center	outpatient	174	87	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	130.5	19.43	130.5
UP EXTM, INFANT 2V LT	UP EXTM, INFANT 2V LT	Radiology	73092	CPT	2001025		Washington Regional Medical Center	outpatient	174	87	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	76.56	19.43	130.5
UP EXTM, INFANT 2V LT	UP EXTM, INFANT 2V LT	Radiology	73092	CPT	2001025		Washington Regional Medical Center	outpatient	174	87	Humana	Medicare Advantage HMO/PPO/PFFS	81.78	19.43	130.5
UP EXTM, INFANT 2V LT	UP EXTM, INFANT 2V LT	Radiology	73092	CPT	2001025		Washington Regional Medical Center	outpatient	174	87	AmeriHealth Caritas North Carolina	NC Medicaid	61.18	19.43	130.5
UP EXTM, INFANT 2V LT	UP EXTM, INFANT 2V LT	Radiology	73092	CPT	2001025		Washington Regional Medical Center	outpatient	174	87	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	61.18	19.43	130.5
UP EXTM, INFANT 2V LT	UP EXTM, INFANT 2V LT	Radiology	73092	CPT	2001025		Washington Regional Medical Center	outpatient	174	87	WellCare of North Carolina	North Carolina Medicaid/CHIP	61.18	19.43	130.5
UP EXTM, INFANT 2V LT	UP EXTM, INFANT 2V LT	Radiology	73092	CPT	2001025		Washington Regional Medical Center	outpatient	174	87	Healthy Blue / Blue Cross NC	North Carolina Medicaid	61.18	19.43	130.5
UP EXTM, INFANT 2V LT	UP EXTM, INFANT 2V LT	Radiology	73092	CPT	2001025		Washington Regional Medical Center	outpatient	174	87	Cigna	North Carolina PPO-PPA Direct	19.43	19.43	130.5
UP EXTM, INFANT 2V LT	UP EXTM, INFANT 2V LT	Radiology	73092	CPT	2001025		Washington Regional Medical Center	outpatient	174	87	Original Medicare	Traditional Medicare Fee-for-Service	81.78	19.43	130.5
UP EXTM, INFANT 2V RT	UP EXTM, INFANT 2V RT	Radiology	73092	CPT	2001026		Washington Regional Medical Center	outpatient	174	87	Self-Pay	Discounted Cash		19.43	130.5
UP EXTM, INFANT 2V RT	UP EXTM, INFANT 2V RT	Radiology	73092	CPT	2001026		Washington Regional Medical Center	outpatient	174	87	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	130.5	19.43	130.5
UP EXTM, INFANT 2V RT	UP EXTM, INFANT 2V RT	Radiology	73092	CPT	2001026		Washington Regional Medical Center	outpatient	174	87	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	76.56	19.43	130.5
UP EXTM, INFANT 2V RT	UP EXTM, INFANT 2V RT	Radiology	73092	CPT	2001026		Washington Regional Medical Center	outpatient	174	87	Humana	Medicare Advantage HMO/PPO/PFFS	81.78	19.43	130.5
UP EXTM, INFANT 2V RT	UP EXTM, INFANT 2V RT	Radiology	73092	CPT	2001026		Washington Regional Medical Center	outpatient	174	87	AmeriHealth Caritas North Carolina	NC Medicaid	61.18	19.43	130.5
UP EXTM, INFANT 2V RT	UP EXTM, INFANT 2V RT	Radiology	73092	CPT	2001026		Washington Regional Medical Center	outpatient	174	87	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	61.18	19.43	130.5
UP EXTM, INFANT 2V RT	UP EXTM, INFANT 2V RT	Radiology	73092	CPT	2001026		Washington Regional Medical Center	outpatient	174	87	WellCare of North Carolina	North Carolina Medicaid/CHIP	61.18	19.43	130.5
UP EXTM, INFANT 2V RT	UP EXTM, INFANT 2V RT	Radiology	73092	CPT	2001026		Washington Regional Medical Center	outpatient	174	87	Healthy Blue / Blue Cross NC	North Carolina Medicaid	61.18	19.43	130.5
UP EXTM, INFANT 2V RT	UP EXTM, INFANT 2V RT	Radiology	73092	CPT	2001026		Washington Regional Medical Center	outpatient	174	87	Cigna	North Carolina PPO-PPA Direct	19.43	19.43	130.5
UP EXTM, INFANT 2V RT	UP EXTM, INFANT 2V RT	Radiology	73092	CPT	2001026		Washington Regional Medical Center	outpatient	174	87	Original Medicare	Traditional Medicare Fee-for-Service	81.78	19.43	130.5
US ABD AOR ANEURYSM	US ABD AOR ANEURYSM	Radiology	76706	CPT	2101127		Washington Regional Medical Center	outpatient	923	461.5	Self-Pay	Discounted Cash		59.63	692.25
US ABD AOR ANEURYSM	US ABD AOR ANEURYSM	Radiology	76706	CPT	2101127		Washington Regional Medical Center	outpatient	923	461.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	692.25	59.63	692.25
US ABD AOR ANEURYSM	US ABD AOR ANEURYSM	Radiology	76706	CPT	2101127		Washington Regional Medical Center	outpatient	923	461.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	406.12	59.63	692.25
US ABD AOR ANEURYSM	US ABD AOR ANEURYSM	Radiology	76706	CPT	2101127		Washington Regional Medical Center	outpatient	923	461.5	Humana	Medicare Advantage HMO/PPO/PFFS	433.81	59.63	692.25
US ABD AOR ANEURYSM	US ABD AOR ANEURYSM	Radiology	76706	CPT	2101127		Washington Regional Medical Center	outpatient	923	461.5	AmeriHealth Caritas North Carolina	NC Medicaid	324.53	59.63	692.25
US ABD AOR ANEURYSM	US ABD AOR ANEURYSM	Radiology	76706	CPT	2101127		Washington Regional Medical Center	outpatient	923	461.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	59.63	59.63	692.25
US ABD AOR ANEURYSM	US ABD AOR ANEURYSM	Radiology	76706	CPT	2101127		Washington Regional Medical Center	outpatient	923	461.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	324.53	59.63	692.25
US ABD AOR ANEURYSM	US ABD AOR ANEURYSM	Radiology	76706	CPT	2101127		Washington Regional Medical Center	outpatient	923	461.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	324.53	59.63	692.25
US ABD AOR ANEURYSM	US ABD AOR ANEURYSM	Radiology	76706	CPT	2101127		Washington Regional Medical Center	outpatient	923	461.5	Cigna	North Carolina PPO-PPA Direct	71.99	59.63	692.25
US ABD AOR ANEURYSM	US ABD AOR ANEURYSM	Radiology	76706	CPT	2101127		Washington Regional Medical Center	outpatient	923	461.5	Original Medicare	Traditional Medicare Fee-for-Service	433.81	59.63	692.25
US CHEST	US CHEST	Radiology	76604	CPT	2101026		Washington Regional Medical Center	outpatient	255	127.5	Self-Pay	Discounted Cash		52.38	191.25
US CHEST	US CHEST	Radiology	76604	CPT	2101026		Washington Regional Medical Center	outpatient	255	127.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	191.25	52.38	191.25
US CHEST	US CHEST	Radiology	76604	CPT	2101026		Washington Regional Medical Center	outpatient	255	127.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	112.2	52.38	191.25
US CHEST	US CHEST	Radiology	76604	CPT	2101026		Washington Regional Medical Center	outpatient	255	127.5	Humana	Medicare Advantage HMO/PPO/PFFS	119.85	52.38	191.25
US CHEST	US CHEST	Radiology	76604	CPT	2101026		Washington Regional Medical Center	outpatient	255	127.5	AmeriHealth Caritas North Carolina	NC Medicaid	89.66	52.38	191.25
US CHEST	US CHEST	Radiology	76604	CPT	2101026		Washington Regional Medical Center	outpatient	255	127.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	89.66	52.38	191.25
US CHEST	US CHEST	Radiology	76604	CPT	2101026		Washington Regional Medical Center	outpatient	255	127.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	89.66	52.38	191.25
US CHEST	US CHEST	Radiology	76604	CPT	2101026		Washington Regional Medical Center	outpatient	255	127.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	89.66	52.38	191.25
US CHEST	US CHEST	Radiology	76604	CPT	2101026		Washington Regional Medical Center	outpatient	255	127.5	Cigna	North Carolina PPO-PPA Direct	52.38	52.38	191.25
US CHEST	US CHEST	Radiology	76604	CPT	2101026		Washington Regional Medical Center	outpatient	255	127.5	Original Medicare	Traditional Medicare Fee-for-Service	119.85	52.38	191.25
US Extremity Non-Vasc Lm 76882	US Extremity Non-Vasc Lm 76882	Radiology	76882	CPT	5291301		Washington Regional Medical Center	outpatient	250	125	Self-Pay	Discounted Cash		11.45	187.5
US Extremity Non-Vasc Lm 76882	US Extremity Non-Vasc Lm 76882	Radiology	76882	CPT	5291301		Washington Regional Medical Center	outpatient	250	125	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	187.5	11.45	187.5
US Extremity Non-Vasc Lm 76882	US Extremity Non-Vasc Lm 76882	Radiology	76882	CPT	5291301		Washington Regional Medical Center	outpatient	250	125	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	110	11.45	187.5
US Extremity Non-Vasc Lm 76882	US Extremity Non-Vasc Lm 76882	Radiology	76882	CPT	5291301		Washington Regional Medical Center	outpatient	250	125	Humana	Medicare Advantage HMO/PPO/PFFS	117.5	11.45	187.5
US Extremity Non-Vasc Lm 76882	US Extremity Non-Vasc Lm 76882	Radiology	76882	CPT	5291301		Washington Regional Medical Center	outpatient	250	125	AmeriHealth Caritas North Carolina	NC Medicaid	87.9	11.45	187.5
US Extremity Non-Vasc Lm 76882	US Extremity Non-Vasc Lm 76882	Radiology	76882	CPT	5291301		Washington Regional Medical Center	outpatient	250	125	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	87.9	11.45	187.5
US Extremity Non-Vasc Lm 76882	US Extremity Non-Vasc Lm 76882	Radiology	76882	CPT	5291301		Washington Regional Medical Center	outpatient	250	125	WellCare of North Carolina	North Carolina Medicaid/CHIP	87.9	11.45	187.5
US Extremity Non-Vasc Lm 76882	US Extremity Non-Vasc Lm 76882	Radiology	76882	CPT	5291301		Washington Regional Medical Center	outpatient	250	125	Healthy Blue / Blue Cross NC	North Carolina Medicaid	87.9	11.45	187.5
US Extremity Non-Vasc Lm 76882	US Extremity Non-Vasc Lm 76882	Radiology	76882	CPT	5291301		Washington Regional Medical Center	outpatient	250	125	Cigna	North Carolina PPO-PPA Direct	11.45	11.45	187.5
US Extremity Non-Vasc Lm 76882	US Extremity Non-Vasc Lm 76882	Radiology	76882	CPT	5291301		Washington Regional Medical Center	outpatient	250	125	Original Medicare	Traditional Medicare Fee-for-Service	117.5	11.45	187.5
US JOINT/NON EXTR, LIMD RT	US JOINT/NON EXTR, LIMD RT	Radiology	76882	CPT	2101106		Washington Regional Medical Center	outpatient	250	125	Self-Pay	Discounted Cash		11.45	187.5
US JOINT/NON EXTR, LIMD RT	US JOINT/NON EXTR, LIMD RT	Radiology	76882	CPT	2101106		Washington Regional Medical Center	outpatient	250	125	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	187.5	11.45	187.5
US JOINT/NON EXTR, LIMD RT	US JOINT/NON EXTR, LIMD RT	Radiology	76882	CPT	2101106		Washington Regional Medical Center	outpatient	250	125	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	110	11.45	187.5
US JOINT/NON EXTR, LIMD RT	US JOINT/NON EXTR, LIMD RT	Radiology	76882	CPT	2101106		Washington Regional Medical Center	outpatient	250	125	Humana	Medicare Advantage HMO/PPO/PFFS	117.5	11.45	187.5
US JOINT/NON EXTR, LIMD RT	US JOINT/NON EXTR, LIMD RT	Radiology	76882	CPT	2101106		Washington Regional Medical Center	outpatient	250	125	AmeriHealth Caritas North Carolina	NC Medicaid	87.9	11.45	187.5
US JOINT/NON EXTR, LIMD RT	US JOINT/NON EXTR, LIMD RT	Radiology	76882	CPT	2101106		Washington Regional Medical Center	outpatient	250	125	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	87.9	11.45	187.5
US JOINT/NON EXTR, LIMD RT	US JOINT/NON EXTR, LIMD RT	Radiology	76882	CPT	2101106		Washington Regional Medical Center	outpatient	250	125	WellCare of North Carolina	North Carolina Medicaid/CHIP	87.9	11.45	187.5
US JOINT/NON EXTR, LIMD RT	US JOINT/NON EXTR, LIMD RT	Radiology	76882	CPT	2101106		Washington Regional Medical Center	outpatient	250	125	Healthy Blue / Blue Cross NC	North Carolina Medicaid	87.9	11.45	187.5
US JOINT/NON EXTR, LIMD RT	US JOINT/NON EXTR, LIMD RT	Radiology	76882	CPT	2101106		Washington Regional Medical Center	outpatient	250	125	Cigna	North Carolina PPO-PPA Direct	11.45	11.45	187.5
US JOINT/NON EXTR, LIMD RT	US JOINT/NON EXTR, LIMD RT	Radiology	76882	CPT	2101106		Washington Regional Medical Center	outpatient	250	125	Original Medicare	Traditional Medicare Fee-for-Service	117.5	11.45	187.5
US JOINT/NONV EXTRE, LIMD LT	US JOINT/NONV EXTRE, LIMD LT	Radiology	76882	CPT	2101105		Washington Regional Medical Center	outpatient	250	125	Self-Pay	Discounted Cash		11.45	187.5
US JOINT/NONV EXTRE, LIMD LT	US JOINT/NONV EXTRE, LIMD LT	Radiology	76882	CPT	2101105		Washington Regional Medical Center	outpatient	250	125	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	187.5	11.45	187.5
US JOINT/NONV EXTRE, LIMD LT	US JOINT/NONV EXTRE, LIMD LT	Radiology	76882	CPT	2101105		Washington Regional Medical Center	outpatient	250	125	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	110	11.45	187.5
US JOINT/NONV EXTRE, LIMD LT	US JOINT/NONV EXTRE, LIMD LT	Radiology	76882	CPT	2101105		Washington Regional Medical Center	outpatient	250	125	Humana	Medicare Advantage HMO/PPO/PFFS	117.5	11.45	187.5
US JOINT/NONV EXTRE, LIMD LT	US JOINT/NONV EXTRE, LIMD LT	Radiology	76882	CPT	2101105		Washington Regional Medical Center	outpatient	250	125	AmeriHealth Caritas North Carolina	NC Medicaid	87.9	11.45	187.5
US JOINT/NONV EXTRE, LIMD LT	US JOINT/NONV EXTRE, LIMD LT	Radiology	76882	CPT	2101105		Washington Regional Medical Center	outpatient	250	125	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	87.9	11.45	187.5
US JOINT/NONV EXTRE, LIMD LT	US JOINT/NONV EXTRE, LIMD LT	Radiology	76882	CPT	2101105		Washington Regional Medical Center	outpatient	250	125	WellCare of North Carolina	North Carolina Medicaid/CHIP	87.9	11.45	187.5
US JOINT/NONV EXTRE, LIMD LT	US JOINT/NONV EXTRE, LIMD LT	Radiology	76882	CPT	2101105		Washington Regional Medical Center	outpatient	250	125	Healthy Blue / Blue Cross NC	North Carolina Medicaid	87.9	11.45	187.5
US JOINT/NONV EXTRE, LIMD LT	US JOINT/NONV EXTRE, LIMD LT	Radiology	76882	CPT	2101105		Washington Regional Medical Center	outpatient	250	125	Cigna	North Carolina PPO-PPA Direct	11.45	11.45	187.5
US JOINT/NONV EXTRE, LIMD LT	US JOINT/NONV EXTRE, LIMD LT	Radiology	76882	CPT	2101105		Washington Regional Medical Center	outpatient	250	125	Original Medicare	Traditional Medicare Fee-for-Service	117.5	11.45	187.5
US JOINT/NONVAS EXTRE, LD	US JOINT/NONVAS EXTRE, LD	Radiology	76882	CPT	2101092		Washington Regional Medical Center	outpatient	150	75	Self-Pay	Discounted Cash		11.45	112.5
US JOINT/NONVAS EXTRE, LD	US JOINT/NONVAS EXTRE, LD	Radiology	76882	CPT	2101092		Washington Regional Medical Center	outpatient	150	75	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	112.5	11.45	112.5
US JOINT/NONVAS EXTRE, LD	US JOINT/NONVAS EXTRE, LD	Radiology	76882	CPT	2101092		Washington Regional Medical Center	outpatient	150	75	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	66	11.45	112.5
US JOINT/NONVAS EXTRE, LD	US JOINT/NONVAS EXTRE, LD	Radiology	76882	CPT	2101092		Washington Regional Medical Center	outpatient	150	75	Humana	Medicare Advantage HMO/PPO/PFFS	70.5	11.45	112.5
US JOINT/NONVAS EXTRE, LD	US JOINT/NONVAS EXTRE, LD	Radiology	76882	CPT	2101092		Washington Regional Medical Center	outpatient	150	75	AmeriHealth Caritas North Carolina	NC Medicaid	52.74	11.45	112.5
US JOINT/NONVAS EXTRE, LD	US JOINT/NONVAS EXTRE, LD	Radiology	76882	CPT	2101092		Washington Regional Medical Center	outpatient	150	75	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	52.74	11.45	112.5
US JOINT/NONVAS EXTRE, LD	US JOINT/NONVAS EXTRE, LD	Radiology	76882	CPT	2101092		Washington Regional Medical Center	outpatient	150	75	WellCare of North Carolina	North Carolina Medicaid/CHIP	52.74	11.45	112.5
US JOINT/NONVAS EXTRE, LD	US JOINT/NONVAS EXTRE, LD	Radiology	76882	CPT	2101092		Washington Regional Medical Center	outpatient	150	75	Healthy Blue / Blue Cross NC	North Carolina Medicaid	52.74	11.45	112.5
US JOINT/NONVAS EXTRE, LD	US JOINT/NONVAS EXTRE, LD	Radiology	76882	CPT	2101092		Washington Regional Medical Center	outpatient	150	75	Cigna	North Carolina PPO-PPA Direct	11.45	11.45	112.5
US JOINT/NONVAS EXTRE, LD	US JOINT/NONVAS EXTRE, LD	Radiology	76882	CPT	2101092		Washington Regional Medical Center	outpatient	150	75	Original Medicare	Traditional Medicare Fee-for-Service	70.5	11.45	112.5
US OB COMPLETE (>14WKS)	US OB COMPLETE (>14WKS)	Radiology	76811	CPT	2101013		Washington Regional Medical Center	outpatient	555	277.5	Self-Pay	Discounted Cash		147.59	416.25
US OB COMPLETE (>14WKS)	US OB COMPLETE (>14WKS)	Radiology	76811	CPT	2101013		Washington Regional Medical Center	outpatient	555	277.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	416.25	147.59	416.25
US OB COMPLETE (>14WKS)	US OB COMPLETE (>14WKS)	Radiology	76811	CPT	2101013		Washington Regional Medical Center	outpatient	555	277.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	244.2	147.59	416.25
US OB COMPLETE (>14WKS)	US OB COMPLETE (>14WKS)	Radiology	76811	CPT	2101013		Washington Regional Medical Center	outpatient	555	277.5	Humana	Medicare Advantage HMO/PPO/PFFS	260.85	147.59	416.25
US OB COMPLETE (>14WKS)	US OB COMPLETE (>14WKS)	Radiology	76811	CPT	2101013		Washington Regional Medical Center	outpatient	555	277.5	AmeriHealth Caritas North Carolina	NC Medicaid	195.14	147.59	416.25
US OB COMPLETE (>14WKS)	US OB COMPLETE (>14WKS)	Radiology	76811	CPT	2101013		Washington Regional Medical Center	outpatient	555	277.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	195.14	147.59	416.25
US OB COMPLETE (>14WKS)	US OB COMPLETE (>14WKS)	Radiology	76811	CPT	2101013		Washington Regional Medical Center	outpatient	555	277.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	195.14	147.59	416.25
US OB COMPLETE (>14WKS)	US OB COMPLETE (>14WKS)	Radiology	76811	CPT	2101013		Washington Regional Medical Center	outpatient	555	277.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	195.14	147.59	416.25
US OB COMPLETE (>14WKS)	US OB COMPLETE (>14WKS)	Radiology	76811	CPT	2101013		Washington Regional Medical Center	outpatient	555	277.5	Cigna	North Carolina PPO-PPA Direct	147.59	147.59	416.25
US OB COMPLETE (>14WKS)	US OB COMPLETE (>14WKS)	Radiology	76811	CPT	2101013		Washington Regional Medical Center	outpatient	555	277.5	Original Medicare	Traditional Medicare Fee-for-Service	260.85	147.59	416.25
US OB F/U	US OB F/U	Radiology	76816	CPT	2101057		Washington Regional Medical Center	outpatient	555	277.5	Self-Pay	Discounted Cash		44.4	416.25
US OB F/U	US OB F/U	Radiology	76816	CPT	2101057		Washington Regional Medical Center	outpatient	555	277.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	416.25	44.4	416.25
US OB F/U	US OB F/U	Radiology	76816	CPT	2101057		Washington Regional Medical Center	outpatient	555	277.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	244.2	44.4	416.25
US OB F/U	US OB F/U	Radiology	76816	CPT	2101057		Washington Regional Medical Center	outpatient	555	277.5	Humana	Medicare Advantage HMO/PPO/PFFS	260.85	44.4	416.25
US OB F/U	US OB F/U	Radiology	76816	CPT	2101057		Washington Regional Medical Center	outpatient	555	277.5	AmeriHealth Caritas North Carolina	NC Medicaid	195.14	44.4	416.25
US OB F/U	US OB F/U	Radiology	76816	CPT	2101057		Washington Regional Medical Center	outpatient	555	277.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	195.14	44.4	416.25
US OB F/U	US OB F/U	Radiology	76816	CPT	2101057		Washington Regional Medical Center	outpatient	555	277.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	195.14	44.4	416.25
US OB F/U	US OB F/U	Radiology	76816	CPT	2101057		Washington Regional Medical Center	outpatient	555	277.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	195.14	44.4	416.25
US OB F/U	US OB F/U	Radiology	76816	CPT	2101057		Washington Regional Medical Center	outpatient	555	277.5	Cigna	North Carolina PPO-PPA Direct	44.4	44.4	416.25
US OB F/U	US OB F/U	Radiology	76816	CPT	2101057		Washington Regional Medical Center	outpatient	555	277.5	Original Medicare	Traditional Medicare Fee-for-Service	260.85	44.4	416.25
US SCROTUM	US SCROTUM	Radiology	76870	CPT	2101036		Washington Regional Medical Center	outpatient	562	281	Self-Pay	Discounted Cash		61.28	421.5
US SCROTUM	US SCROTUM	Radiology	76870	CPT	2101036		Washington Regional Medical Center	outpatient	562	281	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	421.5	61.28	421.5
US SCROTUM	US SCROTUM	Radiology	76870	CPT	2101036		Washington Regional Medical Center	outpatient	562	281	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	247.28	61.28	421.5
US SCROTUM	US SCROTUM	Radiology	76870	CPT	2101036		Washington Regional Medical Center	outpatient	562	281	Humana	Medicare Advantage HMO/PPO/PFFS	264.14	61.28	421.5
US SCROTUM	US SCROTUM	Radiology	76870	CPT	2101036		Washington Regional Medical Center	outpatient	562	281	AmeriHealth Caritas North Carolina	NC Medicaid	197.6	61.28	421.5
US SCROTUM	US SCROTUM	Radiology	76870	CPT	2101036		Washington Regional Medical Center	outpatient	562	281	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	197.6	61.28	421.5
US SCROTUM	US SCROTUM	Radiology	76870	CPT	2101036		Washington Regional Medical Center	outpatient	562	281	WellCare of North Carolina	North Carolina Medicaid/CHIP	197.6	61.28	421.5
US SCROTUM	US SCROTUM	Radiology	76870	CPT	2101036		Washington Regional Medical Center	outpatient	562	281	Healthy Blue / Blue Cross NC	North Carolina Medicaid	197.6	61.28	421.5
US SCROTUM	US SCROTUM	Radiology	76870	CPT	2101036		Washington Regional Medical Center	outpatient	562	281	Cigna	North Carolina PPO-PPA Direct	61.28	61.28	421.5
US SCROTUM	US SCROTUM	Radiology	76870	CPT	2101036		Washington Regional Medical Center	outpatient	562	281	Original Medicare	Traditional Medicare Fee-for-Service	264.14	61.28	421.5
US TRANSPLANT KIDNEY LT	US TRANSPLANT KIDNEY LT	Radiology	76776	CPT	2101082		Washington Regional Medical Center	outpatient	610	305	Self-Pay	Discounted Cash		88.54	457.5
US TRANSPLANT KIDNEY LT	US TRANSPLANT KIDNEY LT	Radiology	76776	CPT	2101082		Washington Regional Medical Center	outpatient	610	305	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	457.5	88.54	457.5
US TRANSPLANT KIDNEY LT	US TRANSPLANT KIDNEY LT	Radiology	76776	CPT	2101082		Washington Regional Medical Center	outpatient	610	305	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	268.4	88.54	457.5
US TRANSPLANT KIDNEY LT	US TRANSPLANT KIDNEY LT	Radiology	76776	CPT	2101082		Washington Regional Medical Center	outpatient	610	305	Humana	Medicare Advantage HMO/PPO/PFFS	286.7	88.54	457.5
US TRANSPLANT KIDNEY LT	US TRANSPLANT KIDNEY LT	Radiology	76776	CPT	2101082		Washington Regional Medical Center	outpatient	610	305	AmeriHealth Caritas North Carolina	NC Medicaid	214.48	88.54	457.5
US TRANSPLANT KIDNEY LT	US TRANSPLANT KIDNEY LT	Radiology	76776	CPT	2101082		Washington Regional Medical Center	outpatient	610	305	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	214.48	88.54	457.5
US TRANSPLANT KIDNEY LT	US TRANSPLANT KIDNEY LT	Radiology	76776	CPT	2101082		Washington Regional Medical Center	outpatient	610	305	WellCare of North Carolina	North Carolina Medicaid/CHIP	214.48	88.54	457.5
US TRANSPLANT KIDNEY LT	US TRANSPLANT KIDNEY LT	Radiology	76776	CPT	2101082		Washington Regional Medical Center	outpatient	610	305	Healthy Blue / Blue Cross NC	North Carolina Medicaid	214.48	88.54	457.5
US TRANSPLANT KIDNEY LT	US TRANSPLANT KIDNEY LT	Radiology	76776	CPT	2101082		Washington Regional Medical Center	outpatient	610	305	Cigna	North Carolina PPO-PPA Direct	88.54	88.54	457.5
US TRANSPLANT KIDNEY LT	US TRANSPLANT KIDNEY LT	Radiology	76776	CPT	2101082		Washington Regional Medical Center	outpatient	610	305	Original Medicare	Traditional Medicare Fee-for-Service	286.7	88.54	457.5
US TRANSPLANT KIDNEY RT	US TRANSPLANT KIDNEY RT	Radiology	76776	CPT	2101083		Washington Regional Medical Center	outpatient	610	305	Self-Pay	Discounted Cash		88.54	457.5
US TRANSPLANT KIDNEY RT	US TRANSPLANT KIDNEY RT	Radiology	76776	CPT	2101083		Washington Regional Medical Center	outpatient	610	305	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	457.5	88.54	457.5
US TRANSPLANT KIDNEY RT	US TRANSPLANT KIDNEY RT	Radiology	76776	CPT	2101083		Washington Regional Medical Center	outpatient	610	305	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	268.4	88.54	457.5
US TRANSPLANT KIDNEY RT	US TRANSPLANT KIDNEY RT	Radiology	76776	CPT	2101083		Washington Regional Medical Center	outpatient	610	305	Humana	Medicare Advantage HMO/PPO/PFFS	286.7	88.54	457.5
US TRANSPLANT KIDNEY RT	US TRANSPLANT KIDNEY RT	Radiology	76776	CPT	2101083		Washington Regional Medical Center	outpatient	610	305	AmeriHealth Caritas North Carolina	NC Medicaid	214.48	88.54	457.5
US TRANSPLANT KIDNEY RT	US TRANSPLANT KIDNEY RT	Radiology	76776	CPT	2101083		Washington Regional Medical Center	outpatient	610	305	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	214.48	88.54	457.5
US TRANSPLANT KIDNEY RT	US TRANSPLANT KIDNEY RT	Radiology	76776	CPT	2101083		Washington Regional Medical Center	outpatient	610	305	WellCare of North Carolina	North Carolina Medicaid/CHIP	214.48	88.54	457.5
US TRANSPLANT KIDNEY RT	US TRANSPLANT KIDNEY RT	Radiology	76776	CPT	2101083		Washington Regional Medical Center	outpatient	610	305	Healthy Blue / Blue Cross NC	North Carolina Medicaid	214.48	88.54	457.5
US TRANSPLANT KIDNEY RT	US TRANSPLANT KIDNEY RT	Radiology	76776	CPT	2101083		Washington Regional Medical Center	outpatient	610	305	Cigna	North Carolina PPO-PPA Direct	88.54	88.54	457.5
US TRANSPLANT KIDNEY RT	US TRANSPLANT KIDNEY RT	Radiology	76776	CPT	2101083		Washington Regional Medical Center	outpatient	610	305	Original Medicare	Traditional Medicare Fee-for-Service	286.7	88.54	457.5
X-Ray, lower back, minimum four views	SPINE LUMBAR MIN 4V	Radiology	72110	CPT	2001078		Washington Regional Medical Center	outpatient	632	316	Self-Pay	Discounted Cash		36.69	474
X-Ray, lower back, minimum four views	SPINE LUMBAR MIN 4V	Radiology	72110	CPT	2001078		Washington Regional Medical Center	outpatient	632	316	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	474	36.69	474
X-Ray, lower back, minimum four views	SPINE LUMBAR MIN 4V	Radiology	72110	CPT	2001078		Washington Regional Medical Center	outpatient	632	316	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	278.08	36.69	474
X-Ray, lower back, minimum four views	SPINE LUMBAR MIN 4V	Radiology	72110	CPT	2001078		Washington Regional Medical Center	outpatient	632	316	Humana	Medicare Advantage HMO/PPO/PFFS	297.04	36.69	474
X-Ray, lower back, minimum four views	SPINE LUMBAR MIN 4V	Radiology	72110	CPT	2001078		Washington Regional Medical Center	outpatient	632	316	AmeriHealth Caritas North Carolina	NC Medicaid	222.21	36.69	474
X-Ray, lower back, minimum four views	SPINE LUMBAR MIN 4V	Radiology	72110	CPT	2001078		Washington Regional Medical Center	outpatient	632	316	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	222.21	36.69	474
X-Ray, lower back, minimum four views	SPINE LUMBAR MIN 4V	Radiology	72110	CPT	2001078		Washington Regional Medical Center	outpatient	632	316	WellCare of North Carolina	North Carolina Medicaid/CHIP	222.21	36.69	474
X-Ray, lower back, minimum four views	SPINE LUMBAR MIN 4V	Radiology	72110	CPT	2001078		Washington Regional Medical Center	outpatient	632	316	Healthy Blue / Blue Cross NC	North Carolina Medicaid	222.21	36.69	474
X-Ray, lower back, minimum four views	SPINE LUMBAR MIN 4V	Radiology	72110	CPT	2001078		Washington Regional Medical Center	outpatient	632	316	Cigna	North Carolina PPO-PPA Direct	36.69	36.69	474
X-Ray, lower back, minimum four views	SPINE LUMBAR MIN 4V	Radiology	72110	CPT	2001078		Washington Regional Medical Center	outpatient	632	316	Original Medicare	Traditional Medicare Fee-for-Service	297.04	36.69	474
XR ABDOMEN MIN 2V	XR ABDOMEN MIN 2V	Radiology	74019	CPT	2000072		Washington Regional Medical Center	outpatient	380	190	Self-Pay	Discounted Cash		23.4	285
XR ABDOMEN MIN 2V	XR ABDOMEN MIN 2V	Radiology	74019	CPT	2000072		Washington Regional Medical Center	outpatient	380	190	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	285	23.4	285
XR ABDOMEN MIN 2V	XR ABDOMEN MIN 2V	Radiology	74019	CPT	2000072		Washington Regional Medical Center	outpatient	380	190	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	167.2	23.4	285
XR ABDOMEN MIN 2V	XR ABDOMEN MIN 2V	Radiology	74019	CPT	2000072		Washington Regional Medical Center	outpatient	380	190	Humana	Medicare Advantage HMO/PPO/PFFS	178.6	23.4	285
XR ABDOMEN MIN 2V	XR ABDOMEN MIN 2V	Radiology	74019	CPT	2000072		Washington Regional Medical Center	outpatient	380	190	AmeriHealth Caritas North Carolina	NC Medicaid	133.61	23.4	285
XR ABDOMEN MIN 2V	XR ABDOMEN MIN 2V	Radiology	74019	CPT	2000072		Washington Regional Medical Center	outpatient	380	190	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	133.61	23.4	285
XR ABDOMEN MIN 2V	XR ABDOMEN MIN 2V	Radiology	74019	CPT	2000072		Washington Regional Medical Center	outpatient	380	190	WellCare of North Carolina	North Carolina Medicaid/CHIP	133.61	23.4	285
XR ABDOMEN MIN 2V	XR ABDOMEN MIN 2V	Radiology	74019	CPT	2000072		Washington Regional Medical Center	outpatient	380	190	Healthy Blue / Blue Cross NC	North Carolina Medicaid	133.61	23.4	285
XR ABDOMEN MIN 2V	XR ABDOMEN MIN 2V	Radiology	74019	CPT	2000072		Washington Regional Medical Center	outpatient	380	190	Cigna	North Carolina PPO-PPA Direct	23.4	23.4	285
XR ABDOMEN MIN 2V	XR ABDOMEN MIN 2V	Radiology	74019	CPT	2000072		Washington Regional Medical Center	outpatient	380	190	Original Medicare	Traditional Medicare Fee-for-Service	178.6	23.4	285
29125-OCC THER STATIC SA SPLIN	29125-OCC THER STATIC SA SPLIN	Surgery	29125	CPT	8010281		Washington Regional Medical Center	outpatient	311	155.5	Self-Pay	Discounted Cash		45.27	233.25
29125-OCC THER STATIC SA SPLIN	29125-OCC THER STATIC SA SPLIN	Surgery	29125	CPT	8010281		Washington Regional Medical Center	outpatient	311	155.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	233.25	45.27	233.25
29125-OCC THER STATIC SA SPLIN	29125-OCC THER STATIC SA SPLIN	Surgery	29125	CPT	8010281		Washington Regional Medical Center	outpatient	311	155.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	136.84	45.27	233.25
29125-OCC THER STATIC SA SPLIN	29125-OCC THER STATIC SA SPLIN	Surgery	29125	CPT	8010281		Washington Regional Medical Center	outpatient	311	155.5	Humana	Medicare Advantage HMO/PPO/PFFS	146.17	45.27	233.25
29125-OCC THER STATIC SA SPLIN	29125-OCC THER STATIC SA SPLIN	Surgery	29125	CPT	8010281		Washington Regional Medical Center	outpatient	311	155.5	AmeriHealth Caritas North Carolina	NC Medicaid	109.35	45.27	233.25
29125-OCC THER STATIC SA SPLIN	29125-OCC THER STATIC SA SPLIN	Surgery	29125	CPT	8010281		Washington Regional Medical Center	outpatient	311	155.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	109.35	45.27	233.25
29125-OCC THER STATIC SA SPLIN	29125-OCC THER STATIC SA SPLIN	Surgery	29125	CPT	8010281		Washington Regional Medical Center	outpatient	311	155.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	109.35	45.27	233.25
29125-OCC THER STATIC SA SPLIN	29125-OCC THER STATIC SA SPLIN	Surgery	29125	CPT	8010281		Washington Regional Medical Center	outpatient	311	155.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	109.35	45.27	233.25
29125-OCC THER STATIC SA SPLIN	29125-OCC THER STATIC SA SPLIN	Surgery	29125	CPT	8010281		Washington Regional Medical Center	outpatient	311	155.5	Cigna	North Carolina PPO-PPA Direct	45.27	45.27	233.25
29125-OCC THER STATIC SA SPLIN	29125-OCC THER STATIC SA SPLIN	Surgery	29125	CPT	8010281		Washington Regional Medical Center	outpatient	311	155.5	Original Medicare	Traditional Medicare Fee-for-Service	146.17	45.27	233.25
Apixaban 5 MG TABLET	Apixaban 5 MG TABLET	Surgery	34067	HCPCS	5640023		Washington Regional Medical Center	outpatient	58.25	29.13	Self-Pay	Discounted Cash		20.48	43.69
Apixaban 5 MG TABLET	Apixaban 5 MG TABLET	Surgery	34067	HCPCS	5640023		Washington Regional Medical Center	outpatient	58.25	29.13	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	43.69	20.48	43.69
Apixaban 5 MG TABLET	Apixaban 5 MG TABLET	Surgery	34067	HCPCS	5640023		Washington Regional Medical Center	outpatient	58.25	29.13	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	25.63	20.48	43.69
Apixaban 5 MG TABLET	Apixaban 5 MG TABLET	Surgery	34067	HCPCS	5640023		Washington Regional Medical Center	outpatient	58.25	29.13	Humana	Medicare Advantage HMO/PPO/PFFS	27.38	20.48	43.69
Apixaban 5 MG TABLET	Apixaban 5 MG TABLET	Surgery	34067	HCPCS	5640023		Washington Regional Medical Center	outpatient	58.25	29.13	AmeriHealth Caritas North Carolina	NC Medicaid	20.48	20.48	43.69
Apixaban 5 MG TABLET	Apixaban 5 MG TABLET	Surgery	34067	HCPCS	5640023		Washington Regional Medical Center	outpatient	58.25	29.13	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	20.48	20.48	43.69
Apixaban 5 MG TABLET	Apixaban 5 MG TABLET	Surgery	34067	HCPCS	5640023		Washington Regional Medical Center	outpatient	58.25	29.13	WellCare of North Carolina	North Carolina Medicaid/CHIP	20.48	20.48	43.69
Apixaban 5 MG TABLET	Apixaban 5 MG TABLET	Surgery	34067	HCPCS	5640023		Washington Regional Medical Center	outpatient	58.25	29.13	Healthy Blue / Blue Cross NC	North Carolina Medicaid	20.48	20.48	43.69
Apixaban 5 MG TABLET	Apixaban 5 MG TABLET	Surgery	34067	HCPCS	5640023		Washington Regional Medical Center	outpatient	58.25	29.13	Original Medicare	Traditional Medicare Fee-for-Service	27.38	20.48	43.69
App Shrt Arm Splnt Static29125	App Shrt Arm Splnt Static29125	Surgery	29125	CPT	2726668		Washington Regional Medical Center	outpatient	311	155.5	Self-Pay	Discounted Cash		45.27	233.25
App Shrt Arm Splnt Static29125	App Shrt Arm Splnt Static29125	Surgery	29125	CPT	2726668		Washington Regional Medical Center	outpatient	311	155.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	233.25	45.27	233.25
App Shrt Arm Splnt Static29125	App Shrt Arm Splnt Static29125	Surgery	29125	CPT	2726668		Washington Regional Medical Center	outpatient	311	155.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	136.84	45.27	233.25
App Shrt Arm Splnt Static29125	App Shrt Arm Splnt Static29125	Surgery	29125	CPT	2726668		Washington Regional Medical Center	outpatient	311	155.5	Humana	Medicare Advantage HMO/PPO/PFFS	146.17	45.27	233.25
App Shrt Arm Splnt Static29125	App Shrt Arm Splnt Static29125	Surgery	29125	CPT	2726668		Washington Regional Medical Center	outpatient	311	155.5	AmeriHealth Caritas North Carolina	NC Medicaid	109.35	45.27	233.25
App Shrt Arm Splnt Static29125	App Shrt Arm Splnt Static29125	Surgery	29125	CPT	2726668		Washington Regional Medical Center	outpatient	311	155.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	109.35	45.27	233.25
App Shrt Arm Splnt Static29125	App Shrt Arm Splnt Static29125	Surgery	29125	CPT	2726668		Washington Regional Medical Center	outpatient	311	155.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	109.35	45.27	233.25
App Shrt Arm Splnt Static29125	App Shrt Arm Splnt Static29125	Surgery	29125	CPT	2726668		Washington Regional Medical Center	outpatient	311	155.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	109.35	45.27	233.25
App Shrt Arm Splnt Static29125	App Shrt Arm Splnt Static29125	Surgery	29125	CPT	2726668		Washington Regional Medical Center	outpatient	311	155.5	Cigna	North Carolina PPO-PPA Direct	45.27	45.27	233.25
App Shrt Arm Splnt Static29125	App Shrt Arm Splnt Static29125	Surgery	29125	CPT	2726668		Washington Regional Medical Center	outpatient	311	155.5	Original Medicare	Traditional Medicare Fee-for-Service	146.17	45.27	233.25
Apply LngLegCastAmbType 29355	Apply LngLegCastAmbType 29355	Surgery	29355	CPT	6120592		Washington Regional Medical Center	outpatient	545.24	272.62	Self-Pay	Discounted Cash		123.68	408.93
Apply LngLegCastAmbType 29355	Apply LngLegCastAmbType 29355	Surgery	29355	CPT	6120592		Washington Regional Medical Center	outpatient	545.24	272.62	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	408.93	123.68	408.93
Apply LngLegCastAmbType 29355	Apply LngLegCastAmbType 29355	Surgery	29355	CPT	6120592		Washington Regional Medical Center	outpatient	545.24	272.62	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	239.91	123.68	408.93
Apply LngLegCastAmbType 29355	Apply LngLegCastAmbType 29355	Surgery	29355	CPT	6120592		Washington Regional Medical Center	outpatient	545.24	272.62	Humana	Medicare Advantage HMO/PPO/PFFS	256.26	123.68	408.93
Apply LngLegCastAmbType 29355	Apply LngLegCastAmbType 29355	Surgery	29355	CPT	6120592		Washington Regional Medical Center	outpatient	545.24	272.62	AmeriHealth Caritas North Carolina	NC Medicaid	191.71	123.68	408.93
Apply LngLegCastAmbType 29355	Apply LngLegCastAmbType 29355	Surgery	29355	CPT	6120592		Washington Regional Medical Center	outpatient	545.24	272.62	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	191.71	123.68	408.93
Apply LngLegCastAmbType 29355	Apply LngLegCastAmbType 29355	Surgery	29355	CPT	6120592		Washington Regional Medical Center	outpatient	545.24	272.62	WellCare of North Carolina	North Carolina Medicaid/CHIP	191.71	123.68	408.93
Apply LngLegCastAmbType 29355	Apply LngLegCastAmbType 29355	Surgery	29355	CPT	6120592		Washington Regional Medical Center	outpatient	545.24	272.62	Healthy Blue / Blue Cross NC	North Carolina Medicaid	191.71	123.68	408.93
Apply LngLegCastAmbType 29355	Apply LngLegCastAmbType 29355	Surgery	29355	CPT	6120592		Washington Regional Medical Center	outpatient	545.24	272.62	Cigna	North Carolina PPO-PPA Direct	123.68	123.68	408.93
Apply LngLegCastAmbType 29355	Apply LngLegCastAmbType 29355	Surgery	29355	CPT	6120592		Washington Regional Medical Center	outpatient	545.24	272.62	Original Medicare	Traditional Medicare Fee-for-Service	256.26	123.68	408.93
APPLY LONG LEG SPLINT	APPLY LONG LEG SPLINT	Surgery	29505	CPT	7501010		Washington Regional Medical Center	outpatient	197.92	98.96	Self-Pay	Discounted Cash		52.35	148.44
APPLY LONG LEG SPLINT	APPLY LONG LEG SPLINT	Surgery	29505	CPT	7501010		Washington Regional Medical Center	outpatient	197.92	98.96	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	148.44	52.35	148.44
APPLY LONG LEG SPLINT	APPLY LONG LEG SPLINT	Surgery	29505	CPT	7501010		Washington Regional Medical Center	outpatient	197.92	98.96	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	87.08	52.35	148.44
APPLY LONG LEG SPLINT	APPLY LONG LEG SPLINT	Surgery	29505	CPT	7501010		Washington Regional Medical Center	outpatient	197.92	98.96	Humana	Medicare Advantage HMO/PPO/PFFS	93.02	52.35	148.44
APPLY LONG LEG SPLINT	APPLY LONG LEG SPLINT	Surgery	29505	CPT	7501010		Washington Regional Medical Center	outpatient	197.92	98.96	AmeriHealth Caritas North Carolina	NC Medicaid	69.59	52.35	148.44
APPLY LONG LEG SPLINT	APPLY LONG LEG SPLINT	Surgery	29505	CPT	7501010		Washington Regional Medical Center	outpatient	197.92	98.96	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	69.59	52.35	148.44
APPLY LONG LEG SPLINT	APPLY LONG LEG SPLINT	Surgery	29505	CPT	7501010		Washington Regional Medical Center	outpatient	197.92	98.96	WellCare of North Carolina	North Carolina Medicaid/CHIP	69.59	52.35	148.44
APPLY LONG LEG SPLINT	APPLY LONG LEG SPLINT	Surgery	29505	CPT	7501010		Washington Regional Medical Center	outpatient	197.92	98.96	Healthy Blue / Blue Cross NC	North Carolina Medicaid	69.59	52.35	148.44
APPLY LONG LEG SPLINT	APPLY LONG LEG SPLINT	Surgery	29505	CPT	7501010		Washington Regional Medical Center	outpatient	197.92	98.96	Cigna	North Carolina PPO-PPA Direct	52.35	52.35	148.44
APPLY LONG LEG SPLINT	APPLY LONG LEG SPLINT	Surgery	29505	CPT	7501010		Washington Regional Medical Center	outpatient	197.92	98.96	Original Medicare	Traditional Medicare Fee-for-Service	93.02	52.35	148.44
Apply Long Leg Splint 29505	Apply Long Leg Splint 29505	Surgery	29505	CPT	4661420		Washington Regional Medical Center	outpatient	99	49.5	Self-Pay	Discounted Cash		34.81	74.25
Apply Long Leg Splint 29505	Apply Long Leg Splint 29505	Surgery	29505	CPT	4661420		Washington Regional Medical Center	outpatient	99	49.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	74.25	34.81	74.25
Apply Long Leg Splint 29505	Apply Long Leg Splint 29505	Surgery	29505	CPT	4661420		Washington Regional Medical Center	outpatient	99	49.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	43.56	34.81	74.25
Apply Long Leg Splint 29505	Apply Long Leg Splint 29505	Surgery	29505	CPT	4661420		Washington Regional Medical Center	outpatient	99	49.5	Humana	Medicare Advantage HMO/PPO/PFFS	46.53	34.81	74.25
Apply Long Leg Splint 29505	Apply Long Leg Splint 29505	Surgery	29505	CPT	4661420		Washington Regional Medical Center	outpatient	99	49.5	AmeriHealth Caritas North Carolina	NC Medicaid	34.81	34.81	74.25
Apply Long Leg Splint 29505	Apply Long Leg Splint 29505	Surgery	29505	CPT	4661420		Washington Regional Medical Center	outpatient	99	49.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	34.81	34.81	74.25
Apply Long Leg Splint 29505	Apply Long Leg Splint 29505	Surgery	29505	CPT	4661420		Washington Regional Medical Center	outpatient	99	49.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	34.81	34.81	74.25
Apply Long Leg Splint 29505	Apply Long Leg Splint 29505	Surgery	29505	CPT	4661420		Washington Regional Medical Center	outpatient	99	49.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	34.81	34.81	74.25
Apply Long Leg Splint 29505	Apply Long Leg Splint 29505	Surgery	29505	CPT	4661420		Washington Regional Medical Center	outpatient	99	49.5	Cigna	North Carolina PPO-PPA Direct	52.35	34.81	74.25
Apply Long Leg Splint 29505	Apply Long Leg Splint 29505	Surgery	29505	CPT	4661420		Washington Regional Medical Center	outpatient	99	49.5	Original Medicare	Traditional Medicare Fee-for-Service	46.53	34.81	74.25
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29125	CPT	6001065		Washington Regional Medical Center	outpatient	311	155.5	Self-Pay	Discounted Cash		45.27	233.25
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29125	CPT	6001065		Washington Regional Medical Center	outpatient	311	155.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	233.25	45.27	233.25
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29125	CPT	6001065		Washington Regional Medical Center	outpatient	311	155.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	136.84	45.27	233.25
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29125	CPT	6001065		Washington Regional Medical Center	outpatient	311	155.5	Humana	Medicare Advantage HMO/PPO/PFFS	146.17	45.27	233.25
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29125	CPT	6001065		Washington Regional Medical Center	outpatient	311	155.5	AmeriHealth Caritas North Carolina	NC Medicaid	109.35	45.27	233.25
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29125	CPT	6001065		Washington Regional Medical Center	outpatient	311	155.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	109.35	45.27	233.25
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29125	CPT	6001065		Washington Regional Medical Center	outpatient	311	155.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	109.35	45.27	233.25
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29125	CPT	6001065		Washington Regional Medical Center	outpatient	311	155.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	109.35	45.27	233.25
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29125	CPT	6001065		Washington Regional Medical Center	outpatient	311	155.5	Cigna	North Carolina PPO-PPA Direct	45.27	45.27	233.25
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29125	CPT	6001065		Washington Regional Medical Center	outpatient	311	155.5	Original Medicare	Traditional Medicare Fee-for-Service	146.17	45.27	233.25
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29125	CPT	7501007		Washington Regional Medical Center	outpatient	255	127.5	Self-Pay	Discounted Cash		45.27	191.25
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29125	CPT	7501007		Washington Regional Medical Center	outpatient	255	127.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	191.25	45.27	191.25
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29125	CPT	7501007		Washington Regional Medical Center	outpatient	255	127.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	112.2	45.27	191.25
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29125	CPT	7501007		Washington Regional Medical Center	outpatient	255	127.5	Humana	Medicare Advantage HMO/PPO/PFFS	119.85	45.27	191.25
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29125	CPT	7501007		Washington Regional Medical Center	outpatient	255	127.5	AmeriHealth Caritas North Carolina	NC Medicaid	89.66	45.27	191.25
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29125	CPT	7501007		Washington Regional Medical Center	outpatient	255	127.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	89.66	45.27	191.25
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29125	CPT	7501007		Washington Regional Medical Center	outpatient	255	127.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	89.66	45.27	191.25
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29125	CPT	7501007		Washington Regional Medical Center	outpatient	255	127.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	89.66	45.27	191.25
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29125	CPT	7501007		Washington Regional Medical Center	outpatient	255	127.5	Cigna	North Carolina PPO-PPA Direct	45.27	45.27	191.25
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29125	CPT	7501007		Washington Regional Medical Center	outpatient	255	127.5	Original Medicare	Traditional Medicare Fee-for-Service	119.85	45.27	191.25
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29505	CPT	8001237		Washington Regional Medical Center	outpatient	575.8	287.9	Self-Pay	Discounted Cash		52.35	431.85
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29505	CPT	8001237		Washington Regional Medical Center	outpatient	575.8	287.9	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	431.85	52.35	431.85
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29505	CPT	8001237		Washington Regional Medical Center	outpatient	575.8	287.9	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	253.35	52.35	431.85
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29505	CPT	8001237		Washington Regional Medical Center	outpatient	575.8	287.9	Humana	Medicare Advantage HMO/PPO/PFFS	270.63	52.35	431.85
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29505	CPT	8001237		Washington Regional Medical Center	outpatient	575.8	287.9	AmeriHealth Caritas North Carolina	NC Medicaid	202.45	52.35	431.85
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29505	CPT	8001237		Washington Regional Medical Center	outpatient	575.8	287.9	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	202.45	52.35	431.85
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29505	CPT	8001237		Washington Regional Medical Center	outpatient	575.8	287.9	WellCare of North Carolina	North Carolina Medicaid/CHIP	202.45	52.35	431.85
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29505	CPT	8001237		Washington Regional Medical Center	outpatient	575.8	287.9	Healthy Blue / Blue Cross NC	North Carolina Medicaid	202.45	52.35	431.85
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29505	CPT	8001237		Washington Regional Medical Center	outpatient	575.8	287.9	Cigna	North Carolina PPO-PPA Direct	52.35	52.35	431.85
APPLY SHORT ARM SPLINT	APPLY SHORT ARM SPLINT	Surgery	29505	CPT	8001237		Washington Regional Medical Center	outpatient	575.8	287.9	Original Medicare	Traditional Medicare Fee-for-Service	270.63	52.35	431.85
Arthro AnkleExcOsteochDf 29891	Arthro AnkleExcOsteochDf 29891	Surgery	29891	CPT	2726702		Washington Regional Medical Center	outpatient	117	58.5	Self-Pay	Discounted Cash		41.14	737.63
Arthro AnkleExcOsteochDf 29891	Arthro AnkleExcOsteochDf 29891	Surgery	29891	CPT	2726702		Washington Regional Medical Center	outpatient	117	58.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	87.75	41.14	737.63
Arthro AnkleExcOsteochDf 29891	Arthro AnkleExcOsteochDf 29891	Surgery	29891	CPT	2726702		Washington Regional Medical Center	outpatient	117	58.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	51.48	41.14	737.63
Arthro AnkleExcOsteochDf 29891	Arthro AnkleExcOsteochDf 29891	Surgery	29891	CPT	2726702		Washington Regional Medical Center	outpatient	117	58.5	Humana	Medicare Advantage HMO/PPO/PFFS	54.99	41.14	737.63
Arthro AnkleExcOsteochDf 29891	Arthro AnkleExcOsteochDf 29891	Surgery	29891	CPT	2726702		Washington Regional Medical Center	outpatient	117	58.5	AmeriHealth Caritas North Carolina	NC Medicaid	41.14	41.14	737.63
Arthro AnkleExcOsteochDf 29891	Arthro AnkleExcOsteochDf 29891	Surgery	29891	CPT	2726702		Washington Regional Medical Center	outpatient	117	58.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	41.14	41.14	737.63
Arthro AnkleExcOsteochDf 29891	Arthro AnkleExcOsteochDf 29891	Surgery	29891	CPT	2726702		Washington Regional Medical Center	outpatient	117	58.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	41.14	41.14	737.63
Arthro AnkleExcOsteochDf 29891	Arthro AnkleExcOsteochDf 29891	Surgery	29891	CPT	2726702		Washington Regional Medical Center	outpatient	117	58.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	41.14	41.14	737.63
Arthro AnkleExcOsteochDf 29891	Arthro AnkleExcOsteochDf 29891	Surgery	29891	CPT	2726702		Washington Regional Medical Center	outpatient	117	58.5	Cigna	North Carolina PPO-PPA Direct	737.63	41.14	737.63
Arthro AnkleExcOsteochDf 29891	Arthro AnkleExcOsteochDf 29891	Surgery	29891	CPT	2726702		Washington Regional Medical Center	outpatient	117	58.5	Original Medicare	Traditional Medicare Fee-for-Service	54.99	41.14	737.63
ArthroKnee AbrsnArthrplst29879	ArthroKnee AbrsnArthrplst29879	Surgery	29879	CPT	2726697		Washington Regional Medical Center	outpatient	117	58.5	Self-Pay	Discounted Cash		41.14	704.86
ArthroKnee AbrsnArthrplst29879	ArthroKnee AbrsnArthrplst29879	Surgery	29879	CPT	2726697		Washington Regional Medical Center	outpatient	117	58.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	87.75	41.14	704.86
ArthroKnee AbrsnArthrplst29879	ArthroKnee AbrsnArthrplst29879	Surgery	29879	CPT	2726697		Washington Regional Medical Center	outpatient	117	58.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	51.48	41.14	704.86
ArthroKnee AbrsnArthrplst29879	ArthroKnee AbrsnArthrplst29879	Surgery	29879	CPT	2726697		Washington Regional Medical Center	outpatient	117	58.5	Humana	Medicare Advantage HMO/PPO/PFFS	54.99	41.14	704.86
ArthroKnee AbrsnArthrplst29879	ArthroKnee AbrsnArthrplst29879	Surgery	29879	CPT	2726697		Washington Regional Medical Center	outpatient	117	58.5	AmeriHealth Caritas North Carolina	NC Medicaid	41.14	41.14	704.86
ArthroKnee AbrsnArthrplst29879	ArthroKnee AbrsnArthrplst29879	Surgery	29879	CPT	2726697		Washington Regional Medical Center	outpatient	117	58.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	41.14	41.14	704.86
ArthroKnee AbrsnArthrplst29879	ArthroKnee AbrsnArthrplst29879	Surgery	29879	CPT	2726697		Washington Regional Medical Center	outpatient	117	58.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	41.14	41.14	704.86
ArthroKnee AbrsnArthrplst29879	ArthroKnee AbrsnArthrplst29879	Surgery	29879	CPT	2726697		Washington Regional Medical Center	outpatient	117	58.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	41.14	41.14	704.86
ArthroKnee AbrsnArthrplst29879	ArthroKnee AbrsnArthrplst29879	Surgery	29879	CPT	2726697		Washington Regional Medical Center	outpatient	117	58.5	Cigna	North Carolina PPO-PPA Direct	704.86	41.14	704.86
ArthroKnee AbrsnArthrplst29879	ArthroKnee AbrsnArthrplst29879	Surgery	29879	CPT	2726697		Washington Regional Medical Center	outpatient	117	58.5	Original Medicare	Traditional Medicare Fee-for-Service	54.99	41.14	704.86
Arthroscopy WristDxW/woBx29840	Arthroscopy WristDxW/woBx29840	Surgery	29840	CPT	8776944		Washington Regional Medical Center	outpatient	140	70	Self-Pay	Discounted Cash		49.22	499.44
Arthroscopy WristDxW/woBx29840	Arthroscopy WristDxW/woBx29840	Surgery	29840	CPT	8776944		Washington Regional Medical Center	outpatient	140	70	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	105	49.22	499.44
Arthroscopy WristDxW/woBx29840	Arthroscopy WristDxW/woBx29840	Surgery	29840	CPT	8776944		Washington Regional Medical Center	outpatient	140	70	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	61.6	49.22	499.44
Arthroscopy WristDxW/woBx29840	Arthroscopy WristDxW/woBx29840	Surgery	29840	CPT	8776944		Washington Regional Medical Center	outpatient	140	70	Humana	Medicare Advantage HMO/PPO/PFFS	65.8	49.22	499.44
Arthroscopy WristDxW/woBx29840	Arthroscopy WristDxW/woBx29840	Surgery	29840	CPT	8776944		Washington Regional Medical Center	outpatient	140	70	AmeriHealth Caritas North Carolina	NC Medicaid	49.22	49.22	499.44
Arthroscopy WristDxW/woBx29840	Arthroscopy WristDxW/woBx29840	Surgery	29840	CPT	8776944		Washington Regional Medical Center	outpatient	140	70	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	49.22	49.22	499.44
Arthroscopy WristDxW/woBx29840	Arthroscopy WristDxW/woBx29840	Surgery	29840	CPT	8776944		Washington Regional Medical Center	outpatient	140	70	WellCare of North Carolina	North Carolina Medicaid/CHIP	49.22	49.22	499.44
Arthroscopy WristDxW/woBx29840	Arthroscopy WristDxW/woBx29840	Surgery	29840	CPT	8776944		Washington Regional Medical Center	outpatient	140	70	Healthy Blue / Blue Cross NC	North Carolina Medicaid	49.22	49.22	499.44
Arthroscopy WristDxW/woBx29840	Arthroscopy WristDxW/woBx29840	Surgery	29840	CPT	8776944		Washington Regional Medical Center	outpatient	140	70	Cigna	North Carolina PPO-PPA Direct	499.44	49.22	499.44
Arthroscopy WristDxW/woBx29840	Arthroscopy WristDxW/woBx29840	Surgery	29840	CPT	8776944		Washington Regional Medical Center	outpatient	140	70	Original Medicare	Traditional Medicare Fee-for-Service	65.8	49.22	499.44
Arthscp Shldr DstClvclct 29824	Arthscp Shldr DstClvclct 29824	Surgery	29824	CPT	2726682		Washington Regional Medical Center	outpatient	6.21	3.11	Self-Pay	Discounted Cash		2.18	732.53
Arthscp Shldr DstClvclct 29824	Arthscp Shldr DstClvclct 29824	Surgery	29824	CPT	2726682		Washington Regional Medical Center	outpatient	6.21	3.11	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	4.66	2.18	732.53
Arthscp Shldr DstClvclct 29824	Arthscp Shldr DstClvclct 29824	Surgery	29824	CPT	2726682		Washington Regional Medical Center	outpatient	6.21	3.11	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	2.73	2.18	732.53
Arthscp Shldr DstClvclct 29824	Arthscp Shldr DstClvclct 29824	Surgery	29824	CPT	2726682		Washington Regional Medical Center	outpatient	6.21	3.11	Humana	Medicare Advantage HMO/PPO/PFFS	2.92	2.18	732.53
Arthscp Shldr DstClvclct 29824	Arthscp Shldr DstClvclct 29824	Surgery	29824	CPT	2726682		Washington Regional Medical Center	outpatient	6.21	3.11	AmeriHealth Caritas North Carolina	NC Medicaid	2.18	2.18	732.53
Arthscp Shldr DstClvclct 29824	Arthscp Shldr DstClvclct 29824	Surgery	29824	CPT	2726682		Washington Regional Medical Center	outpatient	6.21	3.11	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	2.18	2.18	732.53
Arthscp Shldr DstClvclct 29824	Arthscp Shldr DstClvclct 29824	Surgery	29824	CPT	2726682		Washington Regional Medical Center	outpatient	6.21	3.11	WellCare of North Carolina	North Carolina Medicaid/CHIP	2.18	2.18	732.53
Arthscp Shldr DstClvclct 29824	Arthscp Shldr DstClvclct 29824	Surgery	29824	CPT	2726682		Washington Regional Medical Center	outpatient	6.21	3.11	Healthy Blue / Blue Cross NC	North Carolina Medicaid	2.18	2.18	732.53
Arthscp Shldr DstClvclct 29824	Arthscp Shldr DstClvclct 29824	Surgery	29824	CPT	2726682		Washington Regional Medical Center	outpatient	6.21	3.11	Cigna	North Carolina PPO-PPA Direct	732.53	2.18	732.53
Arthscp Shldr DstClvclct 29824	Arthscp Shldr DstClvclct 29824	Surgery	29824	CPT	2726682		Washington Regional Medical Center	outpatient	6.21	3.11	Original Medicare	Traditional Medicare Fee-for-Service	2.92	2.18	732.53
Asp/inj Joint Med w/o US 20605	Asp/inj Joint Med w/o US 20605	Surgery	20605	CPT	2389285		Washington Regional Medical Center	outpatient	180	90	Self-Pay	Discounted Cash		48.4	135
Asp/inj Joint Med w/o US 20605	Asp/inj Joint Med w/o US 20605	Surgery	20605	CPT	2389285		Washington Regional Medical Center	outpatient	180	90	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	135	48.4	135
Asp/inj Joint Med w/o US 20605	Asp/inj Joint Med w/o US 20605	Surgery	20605	CPT	2389285		Washington Regional Medical Center	outpatient	180	90	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	79.2	48.4	135
Asp/inj Joint Med w/o US 20605	Asp/inj Joint Med w/o US 20605	Surgery	20605	CPT	2389285		Washington Regional Medical Center	outpatient	180	90	Humana	Medicare Advantage HMO/PPO/PFFS	84.6	48.4	135
Asp/inj Joint Med w/o US 20605	Asp/inj Joint Med w/o US 20605	Surgery	20605	CPT	2389285		Washington Regional Medical Center	outpatient	180	90	AmeriHealth Caritas North Carolina	NC Medicaid	63.29	48.4	135
Asp/inj Joint Med w/o US 20605	Asp/inj Joint Med w/o US 20605	Surgery	20605	CPT	2389285		Washington Regional Medical Center	outpatient	180	90	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	63.29	48.4	135
Asp/inj Joint Med w/o US 20605	Asp/inj Joint Med w/o US 20605	Surgery	20605	CPT	2389285		Washington Regional Medical Center	outpatient	180	90	WellCare of North Carolina	North Carolina Medicaid/CHIP	63.29	48.4	135
Asp/inj Joint Med w/o US 20605	Asp/inj Joint Med w/o US 20605	Surgery	20605	CPT	2389285		Washington Regional Medical Center	outpatient	180	90	Healthy Blue / Blue Cross NC	North Carolina Medicaid	63.29	48.4	135
Asp/inj Joint Med w/o US 20605	Asp/inj Joint Med w/o US 20605	Surgery	20605	CPT	2389285		Washington Regional Medical Center	outpatient	180	90	Cigna	North Carolina PPO-PPA Direct	48.4	48.4	135
Asp/inj Joint Med w/o US 20605	Asp/inj Joint Med w/o US 20605	Surgery	20605	CPT	2389285		Washington Regional Medical Center	outpatient	180	90	Original Medicare	Traditional Medicare Fee-for-Service	84.6	48.4	135
Asp/inj Joint Med w/o US 20605	Asp/inj Joint Med w/o US 20605	Surgery	20605	CPT	2966330		Washington Regional Medical Center	outpatient	180	90	Self-Pay	Discounted Cash		48.4	135
Asp/inj Joint Med w/o US 20605	Asp/inj Joint Med w/o US 20605	Surgery	20605	CPT	2966330		Washington Regional Medical Center	outpatient	180	90	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	135	48.4	135
Asp/inj Joint Med w/o US 20605	Asp/inj Joint Med w/o US 20605	Surgery	20605	CPT	2966330		Washington Regional Medical Center	outpatient	180	90	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	79.2	48.4	135
Asp/inj Joint Med w/o US 20605	Asp/inj Joint Med w/o US 20605	Surgery	20605	CPT	2966330		Washington Regional Medical Center	outpatient	180	90	Humana	Medicare Advantage HMO/PPO/PFFS	84.6	48.4	135
Asp/inj Joint Med w/o US 20605	Asp/inj Joint Med w/o US 20605	Surgery	20605	CPT	2966330		Washington Regional Medical Center	outpatient	180	90	AmeriHealth Caritas North Carolina	NC Medicaid	63.29	48.4	135
Asp/inj Joint Med w/o US 20605	Asp/inj Joint Med w/o US 20605	Surgery	20605	CPT	2966330		Washington Regional Medical Center	outpatient	180	90	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	63.29	48.4	135
Asp/inj Joint Med w/o US 20605	Asp/inj Joint Med w/o US 20605	Surgery	20605	CPT	2966330		Washington Regional Medical Center	outpatient	180	90	WellCare of North Carolina	North Carolina Medicaid/CHIP	63.29	48.4	135
Asp/inj Joint Med w/o US 20605	Asp/inj Joint Med w/o US 20605	Surgery	20605	CPT	2966330		Washington Regional Medical Center	outpatient	180	90	Healthy Blue / Blue Cross NC	North Carolina Medicaid	63.29	48.4	135
Asp/inj Joint Med w/o US 20605	Asp/inj Joint Med w/o US 20605	Surgery	20605	CPT	2966330		Washington Regional Medical Center	outpatient	180	90	Cigna	North Carolina PPO-PPA Direct	48.4	48.4	135
Asp/inj Joint Med w/o US 20605	Asp/inj Joint Med w/o US 20605	Surgery	20605	CPT	2966330		Washington Regional Medical Center	outpatient	180	90	Original Medicare	Traditional Medicare Fee-for-Service	84.6	48.4	135
ASP/INJECT INTE J/O US GUIDE	ASP/INJECT INTE J/O US GUIDE	Surgery	20605	CPT	6001067		Washington Regional Medical Center	outpatient	180	90	Self-Pay	Discounted Cash		48.4	135
ASP/INJECT INTE J/O US GUIDE	ASP/INJECT INTE J/O US GUIDE	Surgery	20605	CPT	6001067		Washington Regional Medical Center	outpatient	180	90	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	135	48.4	135
ASP/INJECT INTE J/O US GUIDE	ASP/INJECT INTE J/O US GUIDE	Surgery	20605	CPT	6001067		Washington Regional Medical Center	outpatient	180	90	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	79.2	48.4	135
ASP/INJECT INTE J/O US GUIDE	ASP/INJECT INTE J/O US GUIDE	Surgery	20605	CPT	6001067		Washington Regional Medical Center	outpatient	180	90	Humana	Medicare Advantage HMO/PPO/PFFS	84.6	48.4	135
ASP/INJECT INTE J/O US GUIDE	ASP/INJECT INTE J/O US GUIDE	Surgery	20605	CPT	6001067		Washington Regional Medical Center	outpatient	180	90	AmeriHealth Caritas North Carolina	NC Medicaid	63.29	48.4	135
ASP/INJECT INTE J/O US GUIDE	ASP/INJECT INTE J/O US GUIDE	Surgery	20605	CPT	6001067		Washington Regional Medical Center	outpatient	180	90	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	63.29	48.4	135
ASP/INJECT INTE J/O US GUIDE	ASP/INJECT INTE J/O US GUIDE	Surgery	20605	CPT	6001067		Washington Regional Medical Center	outpatient	180	90	WellCare of North Carolina	North Carolina Medicaid/CHIP	63.29	48.4	135
ASP/INJECT INTE J/O US GUIDE	ASP/INJECT INTE J/O US GUIDE	Surgery	20605	CPT	6001067		Washington Regional Medical Center	outpatient	180	90	Healthy Blue / Blue Cross NC	North Carolina Medicaid	63.29	48.4	135
ASP/INJECT INTE J/O US GUIDE	ASP/INJECT INTE J/O US GUIDE	Surgery	20605	CPT	6001067		Washington Regional Medical Center	outpatient	180	90	Cigna	North Carolina PPO-PPA Direct	48.4	48.4	135
ASP/INJECT INTE J/O US GUIDE	ASP/INJECT INTE J/O US GUIDE	Surgery	20605	CPT	6001067		Washington Regional Medical Center	outpatient	180	90	Original Medicare	Traditional Medicare Fee-for-Service	84.6	48.4	135
ASP/INJECT INTERM JT/BURSA W	ASP/INJECT INTERM JT/BURSA W	Surgery	20605	CPT	7501072		Washington Regional Medical Center	outpatient	180	90	Self-Pay	Discounted Cash		48.4	135
ASP/INJECT INTERM JT/BURSA W	ASP/INJECT INTERM JT/BURSA W	Surgery	20605	CPT	7501072		Washington Regional Medical Center	outpatient	180	90	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	135	48.4	135
ASP/INJECT INTERM JT/BURSA W	ASP/INJECT INTERM JT/BURSA W	Surgery	20605	CPT	7501072		Washington Regional Medical Center	outpatient	180	90	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	79.2	48.4	135
ASP/INJECT INTERM JT/BURSA W	ASP/INJECT INTERM JT/BURSA W	Surgery	20605	CPT	7501072		Washington Regional Medical Center	outpatient	180	90	Humana	Medicare Advantage HMO/PPO/PFFS	84.6	48.4	135
ASP/INJECT INTERM JT/BURSA W	ASP/INJECT INTERM JT/BURSA W	Surgery	20605	CPT	7501072		Washington Regional Medical Center	outpatient	180	90	AmeriHealth Caritas North Carolina	NC Medicaid	63.29	48.4	135
ASP/INJECT INTERM JT/BURSA W	ASP/INJECT INTERM JT/BURSA W	Surgery	20605	CPT	7501072		Washington Regional Medical Center	outpatient	180	90	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	63.29	48.4	135
ASP/INJECT INTERM JT/BURSA W	ASP/INJECT INTERM JT/BURSA W	Surgery	20605	CPT	7501072		Washington Regional Medical Center	outpatient	180	90	WellCare of North Carolina	North Carolina Medicaid/CHIP	63.29	48.4	135
ASP/INJECT INTERM JT/BURSA W	ASP/INJECT INTERM JT/BURSA W	Surgery	20605	CPT	7501072		Washington Regional Medical Center	outpatient	180	90	Healthy Blue / Blue Cross NC	North Carolina Medicaid	63.29	48.4	135
ASP/INJECT INTERM JT/BURSA W	ASP/INJECT INTERM JT/BURSA W	Surgery	20605	CPT	7501072		Washington Regional Medical Center	outpatient	180	90	Cigna	North Carolina PPO-PPA Direct	48.4	48.4	135
ASP/INJECT INTERM JT/BURSA W	ASP/INJECT INTERM JT/BURSA W	Surgery	20605	CPT	7501072		Washington Regional Medical Center	outpatient	180	90	Original Medicare	Traditional Medicare Fee-for-Service	84.6	48.4	135
ASP/INJECT INTERM W/O US GUI	ASP/INJECT INTERM W/O US GUI	Surgery	20605	CPT	8001047		Washington Regional Medical Center	outpatient	180	90	Self-Pay	Discounted Cash		48.4	135
ASP/INJECT INTERM W/O US GUI	ASP/INJECT INTERM W/O US GUI	Surgery	20605	CPT	8001047		Washington Regional Medical Center	outpatient	180	90	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	135	48.4	135
ASP/INJECT INTERM W/O US GUI	ASP/INJECT INTERM W/O US GUI	Surgery	20605	CPT	8001047		Washington Regional Medical Center	outpatient	180	90	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	79.2	48.4	135
ASP/INJECT INTERM W/O US GUI	ASP/INJECT INTERM W/O US GUI	Surgery	20605	CPT	8001047		Washington Regional Medical Center	outpatient	180	90	Humana	Medicare Advantage HMO/PPO/PFFS	84.6	48.4	135
ASP/INJECT INTERM W/O US GUI	ASP/INJECT INTERM W/O US GUI	Surgery	20605	CPT	8001047		Washington Regional Medical Center	outpatient	180	90	AmeriHealth Caritas North Carolina	NC Medicaid	63.29	48.4	135
ASP/INJECT INTERM W/O US GUI	ASP/INJECT INTERM W/O US GUI	Surgery	20605	CPT	8001047		Washington Regional Medical Center	outpatient	180	90	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	63.29	48.4	135
ASP/INJECT INTERM W/O US GUI	ASP/INJECT INTERM W/O US GUI	Surgery	20605	CPT	8001047		Washington Regional Medical Center	outpatient	180	90	WellCare of North Carolina	North Carolina Medicaid/CHIP	63.29	48.4	135
ASP/INJECT INTERM W/O US GUI	ASP/INJECT INTERM W/O US GUI	Surgery	20605	CPT	8001047		Washington Regional Medical Center	outpatient	180	90	Healthy Blue / Blue Cross NC	North Carolina Medicaid	63.29	48.4	135
ASP/INJECT INTERM W/O US GUI	ASP/INJECT INTERM W/O US GUI	Surgery	20605	CPT	8001047		Washington Regional Medical Center	outpatient	180	90	Cigna	North Carolina PPO-PPA Direct	48.4	48.4	135
ASP/INJECT INTERM W/O US GUI	ASP/INJECT INTERM W/O US GUI	Surgery	20605	CPT	8001047		Washington Regional Medical Center	outpatient	180	90	Original Medicare	Traditional Medicare Fee-for-Service	84.6	48.4	135
Cerumen Rem instr unilat 69210	Cerumen Rem instr unilat 69210	Surgery	69210	CPT	2727165		Washington Regional Medical Center	outpatient	129.32	64.66	Self-Pay	Discounted Cash		38.87	96.99
Cerumen Rem instr unilat 69210	Cerumen Rem instr unilat 69210	Surgery	69210	CPT	2727165		Washington Regional Medical Center	outpatient	129.32	64.66	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	96.99	38.87	96.99
Cerumen Rem instr unilat 69210	Cerumen Rem instr unilat 69210	Surgery	69210	CPT	2727165		Washington Regional Medical Center	outpatient	129.32	64.66	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	56.9	38.87	96.99
Cerumen Rem instr unilat 69210	Cerumen Rem instr unilat 69210	Surgery	69210	CPT	2727165		Washington Regional Medical Center	outpatient	129.32	64.66	Humana	Medicare Advantage HMO/PPO/PFFS	60.78	38.87	96.99
Cerumen Rem instr unilat 69210	Cerumen Rem instr unilat 69210	Surgery	69210	CPT	2727165		Washington Regional Medical Center	outpatient	129.32	64.66	AmeriHealth Caritas North Carolina	NC Medicaid	45.47	38.87	96.99
Cerumen Rem instr unilat 69210	Cerumen Rem instr unilat 69210	Surgery	69210	CPT	2727165		Washington Regional Medical Center	outpatient	129.32	64.66	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	45.47	38.87	96.99
Cerumen Rem instr unilat 69210	Cerumen Rem instr unilat 69210	Surgery	69210	CPT	2727165		Washington Regional Medical Center	outpatient	129.32	64.66	WellCare of North Carolina	North Carolina Medicaid/CHIP	45.47	38.87	96.99
Cerumen Rem instr unilat 69210	Cerumen Rem instr unilat 69210	Surgery	69210	CPT	2727165		Washington Regional Medical Center	outpatient	129.32	64.66	Healthy Blue / Blue Cross NC	North Carolina Medicaid	45.47	38.87	96.99
Cerumen Rem instr unilat 69210	Cerumen Rem instr unilat 69210	Surgery	69210	CPT	2727165		Washington Regional Medical Center	outpatient	129.32	64.66	Cigna	North Carolina PPO-PPA Direct	38.87	38.87	96.99
Cerumen Rem instr unilat 69210	Cerumen Rem instr unilat 69210	Surgery	69210	CPT	2727165		Washington Regional Medical Center	outpatient	129.32	64.66	Original Medicare	Traditional Medicare Fee-for-Service	60.78	38.87	96.99
ClTx Foot Jnt Disl w/oAn 28600	ClTx Foot Jnt Disl w/oAn 28600	Surgery	28600	CPT	9632919		Washington Regional Medical Center	outpatient	741	370.5	Self-Pay	Discounted Cash		206.55	555.75
ClTx Foot Jnt Disl w/oAn 28600	ClTx Foot Jnt Disl w/oAn 28600	Surgery	28600	CPT	9632919		Washington Regional Medical Center	outpatient	741	370.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	555.75	206.55	555.75
ClTx Foot Jnt Disl w/oAn 28600	ClTx Foot Jnt Disl w/oAn 28600	Surgery	28600	CPT	9632919		Washington Regional Medical Center	outpatient	741	370.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	326.04	206.55	555.75
ClTx Foot Jnt Disl w/oAn 28600	ClTx Foot Jnt Disl w/oAn 28600	Surgery	28600	CPT	9632919		Washington Regional Medical Center	outpatient	741	370.5	Humana	Medicare Advantage HMO/PPO/PFFS	348.27	206.55	555.75
ClTx Foot Jnt Disl w/oAn 28600	ClTx Foot Jnt Disl w/oAn 28600	Surgery	28600	CPT	9632919		Washington Regional Medical Center	outpatient	741	370.5	AmeriHealth Caritas North Carolina	NC Medicaid	260.54	206.55	555.75
ClTx Foot Jnt Disl w/oAn 28600	ClTx Foot Jnt Disl w/oAn 28600	Surgery	28600	CPT	9632919		Washington Regional Medical Center	outpatient	741	370.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	260.54	206.55	555.75
ClTx Foot Jnt Disl w/oAn 28600	ClTx Foot Jnt Disl w/oAn 28600	Surgery	28600	CPT	9632919		Washington Regional Medical Center	outpatient	741	370.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	260.54	206.55	555.75
ClTx Foot Jnt Disl w/oAn 28600	ClTx Foot Jnt Disl w/oAn 28600	Surgery	28600	CPT	9632919		Washington Regional Medical Center	outpatient	741	370.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	260.54	206.55	555.75
ClTx Foot Jnt Disl w/oAn 28600	ClTx Foot Jnt Disl w/oAn 28600	Surgery	28600	CPT	9632919		Washington Regional Medical Center	outpatient	741	370.5	Cigna	North Carolina PPO-PPA Direct	206.55	206.55	555.75
ClTx Foot Jnt Disl w/oAn 28600	ClTx Foot Jnt Disl w/oAn 28600	Surgery	28600	CPT	9632919		Washington Regional Medical Center	outpatient	741	370.5	Original Medicare	Traditional Medicare Fee-for-Service	348.27	206.55	555.75
ClTx Radl&Ulnr Shft w/om 25560	ClTx Radl&Ulnr Shft w/om 25560	Surgery	25560	CPT	2726553		Washington Regional Medical Center	outpatient	1018.8	509.4	Self-Pay	Discounted Cash		229.94	764.1
ClTx Radl&Ulnr Shft w/om 25560	ClTx Radl&Ulnr Shft w/om 25560	Surgery	25560	CPT	2726553		Washington Regional Medical Center	outpatient	1018.8	509.4	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	764.1	229.94	764.1
ClTx Radl&Ulnr Shft w/om 25560	ClTx Radl&Ulnr Shft w/om 25560	Surgery	25560	CPT	2726553		Washington Regional Medical Center	outpatient	1018.8	509.4	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	448.27	229.94	764.1
ClTx Radl&Ulnr Shft w/om 25560	ClTx Radl&Ulnr Shft w/om 25560	Surgery	25560	CPT	2726553		Washington Regional Medical Center	outpatient	1018.8	509.4	Humana	Medicare Advantage HMO/PPO/PFFS	478.84	229.94	764.1
ClTx Radl&Ulnr Shft w/om 25560	ClTx Radl&Ulnr Shft w/om 25560	Surgery	25560	CPT	2726553		Washington Regional Medical Center	outpatient	1018.8	509.4	AmeriHealth Caritas North Carolina	NC Medicaid	358.21	229.94	764.1
ClTx Radl&Ulnr Shft w/om 25560	ClTx Radl&Ulnr Shft w/om 25560	Surgery	25560	CPT	2726553		Washington Regional Medical Center	outpatient	1018.8	509.4	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	358.21	229.94	764.1
ClTx Radl&Ulnr Shft w/om 25560	ClTx Radl&Ulnr Shft w/om 25560	Surgery	25560	CPT	2726553		Washington Regional Medical Center	outpatient	1018.8	509.4	WellCare of North Carolina	North Carolina Medicaid/CHIP	358.21	229.94	764.1
ClTx Radl&Ulnr Shft w/om 25560	ClTx Radl&Ulnr Shft w/om 25560	Surgery	25560	CPT	2726553		Washington Regional Medical Center	outpatient	1018.8	509.4	Healthy Blue / Blue Cross NC	North Carolina Medicaid	358.21	229.94	764.1
ClTx Radl&Ulnr Shft w/om 25560	ClTx Radl&Ulnr Shft w/om 25560	Surgery	25560	CPT	2726553		Washington Regional Medical Center	outpatient	1018.8	509.4	Cigna	North Carolina PPO-PPA Direct	229.94	229.94	764.1
ClTx Radl&Ulnr Shft w/om 25560	ClTx Radl&Ulnr Shft w/om 25560	Surgery	25560	CPT	2726553		Washington Regional Medical Center	outpatient	1018.8	509.4	Original Medicare	Traditional Medicare Fee-for-Service	478.84	229.94	764.1
Debride Skin/musc/bn Fx 11012	Debride Skin/musc/bn Fx 11012	Surgery	11012	CPT	2726323		Washington Regional Medical Center	outpatient	3180	1590	Self-Pay	Discounted Cash		506.56	2385
Debride Skin/musc/bn Fx 11012	Debride Skin/musc/bn Fx 11012	Surgery	11012	CPT	2726323		Washington Regional Medical Center	outpatient	3180	1590	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	2385	506.56	2385
Debride Skin/musc/bn Fx 11012	Debride Skin/musc/bn Fx 11012	Surgery	11012	CPT	2726323		Washington Regional Medical Center	outpatient	3180	1590	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	1399.2	506.56	2385
Debride Skin/musc/bn Fx 11012	Debride Skin/musc/bn Fx 11012	Surgery	11012	CPT	2726323		Washington Regional Medical Center	outpatient	3180	1590	Humana	Medicare Advantage HMO/PPO/PFFS	1494.6	506.56	2385
Debride Skin/musc/bn Fx 11012	Debride Skin/musc/bn Fx 11012	Surgery	11012	CPT	2726323		Washington Regional Medical Center	outpatient	3180	1590	AmeriHealth Caritas North Carolina	NC Medicaid	1118.09	506.56	2385
Debride Skin/musc/bn Fx 11012	Debride Skin/musc/bn Fx 11012	Surgery	11012	CPT	2726323		Washington Regional Medical Center	outpatient	3180	1590	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	1118.09	506.56	2385
Debride Skin/musc/bn Fx 11012	Debride Skin/musc/bn Fx 11012	Surgery	11012	CPT	2726323		Washington Regional Medical Center	outpatient	3180	1590	WellCare of North Carolina	North Carolina Medicaid/CHIP	1118.09	506.56	2385
Debride Skin/musc/bn Fx 11012	Debride Skin/musc/bn Fx 11012	Surgery	11012	CPT	2726323		Washington Regional Medical Center	outpatient	3180	1590	Healthy Blue / Blue Cross NC	North Carolina Medicaid	1118.09	506.56	2385
Debride Skin/musc/bn Fx 11012	Debride Skin/musc/bn Fx 11012	Surgery	11012	CPT	2726323		Washington Regional Medical Center	outpatient	3180	1590	Cigna	North Carolina PPO-PPA Direct	506.56	506.56	2385
Debride Skin/musc/bn Fx 11012	Debride Skin/musc/bn Fx 11012	Surgery	11012	CPT	2726323		Washington Regional Medical Center	outpatient	3180	1590	Original Medicare	Traditional Medicare Fee-for-Service	1494.6	506.56	2385
Drain Ext Audt Canal Les 69020	Drain Ext Audt Canal Les 69020	Surgery	69020	CPT	8796947		Washington Regional Medical Center	outpatient	560.44	280.22	Self-Pay	Discounted Cash		157.46	420.33
Drain Ext Audt Canal Les 69020	Drain Ext Audt Canal Les 69020	Surgery	69020	CPT	8796947		Washington Regional Medical Center	outpatient	560.44	280.22	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	420.33	157.46	420.33
Drain Ext Audt Canal Les 69020	Drain Ext Audt Canal Les 69020	Surgery	69020	CPT	8796947		Washington Regional Medical Center	outpatient	560.44	280.22	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	246.59	157.46	420.33
Drain Ext Audt Canal Les 69020	Drain Ext Audt Canal Les 69020	Surgery	69020	CPT	8796947		Washington Regional Medical Center	outpatient	560.44	280.22	Humana	Medicare Advantage HMO/PPO/PFFS	263.41	157.46	420.33
Drain Ext Audt Canal Les 69020	Drain Ext Audt Canal Les 69020	Surgery	69020	CPT	8796947		Washington Regional Medical Center	outpatient	560.44	280.22	AmeriHealth Caritas North Carolina	NC Medicaid	197.05	157.46	420.33
Drain Ext Audt Canal Les 69020	Drain Ext Audt Canal Les 69020	Surgery	69020	CPT	8796947		Washington Regional Medical Center	outpatient	560.44	280.22	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	197.05	157.46	420.33
Drain Ext Audt Canal Les 69020	Drain Ext Audt Canal Les 69020	Surgery	69020	CPT	8796947		Washington Regional Medical Center	outpatient	560.44	280.22	WellCare of North Carolina	North Carolina Medicaid/CHIP	197.05	157.46	420.33
Drain Ext Audt Canal Les 69020	Drain Ext Audt Canal Les 69020	Surgery	69020	CPT	8796947		Washington Regional Medical Center	outpatient	560.44	280.22	Healthy Blue / Blue Cross NC	North Carolina Medicaid	197.05	157.46	420.33
Drain Ext Audt Canal Les 69020	Drain Ext Audt Canal Les 69020	Surgery	69020	CPT	8796947		Washington Regional Medical Center	outpatient	560.44	280.22	Cigna	North Carolina PPO-PPA Direct	157.46	157.46	420.33
Drain Ext Audt Canal Les 69020	Drain Ext Audt Canal Les 69020	Surgery	69020	CPT	8796947		Washington Regional Medical Center	outpatient	560.44	280.22	Original Medicare	Traditional Medicare Fee-for-Service	263.41	157.46	420.33
DRESS/DEB PARL BURNS>10% BS	DRESS/DEB PARL BURNS>10% BS	Surgery	16030	CPT	6001270		Washington Regional Medical Center	outpatient	985	492.5	Self-Pay	Discounted Cash		148.69	738.75
DRESS/DEB PARL BURNS>10% BS	DRESS/DEB PARL BURNS>10% BS	Surgery	16030	CPT	6001270		Washington Regional Medical Center	outpatient	985	492.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	738.75	148.69	738.75
DRESS/DEB PARL BURNS>10% BS	DRESS/DEB PARL BURNS>10% BS	Surgery	16030	CPT	6001270		Washington Regional Medical Center	outpatient	985	492.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	433.4	148.69	738.75
DRESS/DEB PARL BURNS>10% BS	DRESS/DEB PARL BURNS>10% BS	Surgery	16030	CPT	6001270		Washington Regional Medical Center	outpatient	985	492.5	Humana	Medicare Advantage HMO/PPO/PFFS	462.95	148.69	738.75
DRESS/DEB PARL BURNS>10% BS	DRESS/DEB PARL BURNS>10% BS	Surgery	16030	CPT	6001270		Washington Regional Medical Center	outpatient	985	492.5	AmeriHealth Caritas North Carolina	NC Medicaid	346.33	148.69	738.75
DRESS/DEB PARL BURNS>10% BS	DRESS/DEB PARL BURNS>10% BS	Surgery	16030	CPT	6001270		Washington Regional Medical Center	outpatient	985	492.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	346.33	148.69	738.75
DRESS/DEB PARL BURNS>10% BS	DRESS/DEB PARL BURNS>10% BS	Surgery	16030	CPT	6001270		Washington Regional Medical Center	outpatient	985	492.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	346.33	148.69	738.75
DRESS/DEB PARL BURNS>10% BS	DRESS/DEB PARL BURNS>10% BS	Surgery	16030	CPT	6001270		Washington Regional Medical Center	outpatient	985	492.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	346.33	148.69	738.75
DRESS/DEB PARL BURNS>10% BS	DRESS/DEB PARL BURNS>10% BS	Surgery	16030	CPT	6001270		Washington Regional Medical Center	outpatient	985	492.5	Cigna	North Carolina PPO-PPA Direct	148.69	148.69	738.75
DRESS/DEB PARL BURNS>10% BS	DRESS/DEB PARL BURNS>10% BS	Surgery	16030	CPT	6001270		Washington Regional Medical Center	outpatient	985	492.5	Original Medicare	Traditional Medicare Fee-for-Service	462.95	148.69	738.75
DRS/DBRDMT PRTL 1ST DEGREE BURN	DRS/DBRDMT PRTL 1ST DEGREE BURN	Surgery	16030	CPT	6001104		Washington Regional Medical Center	outpatient	550.2	275.1	Self-Pay	Discounted Cash		148.69	412.65
DRS/DBRDMT PRTL 1ST DEGREE BURN	DRS/DBRDMT PRTL 1ST DEGREE BURN	Surgery	16030	CPT	6001104		Washington Regional Medical Center	outpatient	550.2	275.1	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	412.65	148.69	412.65
DRS/DBRDMT PRTL 1ST DEGREE BURN	DRS/DBRDMT PRTL 1ST DEGREE BURN	Surgery	16030	CPT	6001104		Washington Regional Medical Center	outpatient	550.2	275.1	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	242.09	148.69	412.65
DRS/DBRDMT PRTL 1ST DEGREE BURN	DRS/DBRDMT PRTL 1ST DEGREE BURN	Surgery	16030	CPT	6001104		Washington Regional Medical Center	outpatient	550.2	275.1	Humana	Medicare Advantage HMO/PPO/PFFS	258.59	148.69	412.65
DRS/DBRDMT PRTL 1ST DEGREE BURN	DRS/DBRDMT PRTL 1ST DEGREE BURN	Surgery	16030	CPT	6001104		Washington Regional Medical Center	outpatient	550.2	275.1	AmeriHealth Caritas North Carolina	NC Medicaid	193.45	148.69	412.65
DRS/DBRDMT PRTL 1ST DEGREE BURN	DRS/DBRDMT PRTL 1ST DEGREE BURN	Surgery	16030	CPT	6001104		Washington Regional Medical Center	outpatient	550.2	275.1	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	193.45	148.69	412.65
DRS/DBRDMT PRTL 1ST DEGREE BURN	DRS/DBRDMT PRTL 1ST DEGREE BURN	Surgery	16030	CPT	6001104		Washington Regional Medical Center	outpatient	550.2	275.1	WellCare of North Carolina	North Carolina Medicaid/CHIP	193.45	148.69	412.65
DRS/DBRDMT PRTL 1ST DEGREE BURN	DRS/DBRDMT PRTL 1ST DEGREE BURN	Surgery	16030	CPT	6001104		Washington Regional Medical Center	outpatient	550.2	275.1	Healthy Blue / Blue Cross NC	North Carolina Medicaid	193.45	148.69	412.65
DRS/DBRDMT PRTL 1ST DEGREE BURN	DRS/DBRDMT PRTL 1ST DEGREE BURN	Surgery	16030	CPT	6001104		Washington Regional Medical Center	outpatient	550.2	275.1	Cigna	North Carolina PPO-PPA Direct	148.69	148.69	412.65
DRS/DBRDMT PRTL 1ST DEGREE BURN	DRS/DBRDMT PRTL 1ST DEGREE BURN	Surgery	16030	CPT	6001104		Washington Regional Medical Center	outpatient	550.2	275.1	Original Medicare	Traditional Medicare Fee-for-Service	258.59	148.69	412.65
Dst Mal Lsn t/a/l0.6-1cmd17261	Dst Mal Lsn t/a/l0.6-1cmd17261	Surgery	17261	CPT	2726442		Washington Regional Medical Center	outpatient	344	172	Self-Pay	Discounted Cash		89.58	258
Dst Mal Lsn t/a/l0.6-1cmd17261	Dst Mal Lsn t/a/l0.6-1cmd17261	Surgery	17261	CPT	2726442		Washington Regional Medical Center	outpatient	344	172	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	258	89.58	258
Dst Mal Lsn t/a/l0.6-1cmd17261	Dst Mal Lsn t/a/l0.6-1cmd17261	Surgery	17261	CPT	2726442		Washington Regional Medical Center	outpatient	344	172	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	151.36	89.58	258
Dst Mal Lsn t/a/l0.6-1cmd17261	Dst Mal Lsn t/a/l0.6-1cmd17261	Surgery	17261	CPT	2726442		Washington Regional Medical Center	outpatient	344	172	Humana	Medicare Advantage HMO/PPO/PFFS	161.68	89.58	258
Dst Mal Lsn t/a/l0.6-1cmd17261	Dst Mal Lsn t/a/l0.6-1cmd17261	Surgery	17261	CPT	2726442		Washington Regional Medical Center	outpatient	344	172	AmeriHealth Caritas North Carolina	NC Medicaid	120.95	89.58	258
Dst Mal Lsn t/a/l0.6-1cmd17261	Dst Mal Lsn t/a/l0.6-1cmd17261	Surgery	17261	CPT	2726442		Washington Regional Medical Center	outpatient	344	172	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	120.95	89.58	258
Dst Mal Lsn t/a/l0.6-1cmd17261	Dst Mal Lsn t/a/l0.6-1cmd17261	Surgery	17261	CPT	2726442		Washington Regional Medical Center	outpatient	344	172	WellCare of North Carolina	North Carolina Medicaid/CHIP	120.95	89.58	258
Dst Mal Lsn t/a/l0.6-1cmd17261	Dst Mal Lsn t/a/l0.6-1cmd17261	Surgery	17261	CPT	2726442		Washington Regional Medical Center	outpatient	344	172	Healthy Blue / Blue Cross NC	North Carolina Medicaid	120.95	89.58	258
Dst Mal Lsn t/a/l0.6-1cmd17261	Dst Mal Lsn t/a/l0.6-1cmd17261	Surgery	17261	CPT	2726442		Washington Regional Medical Center	outpatient	344	172	Cigna	North Carolina PPO-PPA Direct	89.58	89.58	258
Dst Mal Lsn t/a/l0.6-1cmd17261	Dst Mal Lsn t/a/l0.6-1cmd17261	Surgery	17261	CPT	2726442		Washington Regional Medical Center	outpatient	344	172	Original Medicare	Traditional Medicare Fee-for-Service	161.68	89.58	258
Exc Bgn Lesion w/Margins 11404	Exc Bgn Lesion w/Margins 11404	Surgery	11404	CPT	2726350		Washington Regional Medical Center	outpatient	2366	1183	Self-Pay	Discounted Cash		158.69	1774.5
Exc Bgn Lesion w/Margins 11404	Exc Bgn Lesion w/Margins 11404	Surgery	11404	CPT	2726350		Washington Regional Medical Center	outpatient	2366	1183	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1774.5	158.69	1774.5
Exc Bgn Lesion w/Margins 11404	Exc Bgn Lesion w/Margins 11404	Surgery	11404	CPT	2726350		Washington Regional Medical Center	outpatient	2366	1183	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	1041.04	158.69	1774.5
Exc Bgn Lesion w/Margins 11404	Exc Bgn Lesion w/Margins 11404	Surgery	11404	CPT	2726350		Washington Regional Medical Center	outpatient	2366	1183	Humana	Medicare Advantage HMO/PPO/PFFS	1112.02	158.69	1774.5
Exc Bgn Lesion w/Margins 11404	Exc Bgn Lesion w/Margins 11404	Surgery	11404	CPT	2726350		Washington Regional Medical Center	outpatient	2366	1183	AmeriHealth Caritas North Carolina	NC Medicaid	831.89	158.69	1774.5
Exc Bgn Lesion w/Margins 11404	Exc Bgn Lesion w/Margins 11404	Surgery	11404	CPT	2726350		Washington Regional Medical Center	outpatient	2366	1183	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	831.89	158.69	1774.5
Exc Bgn Lesion w/Margins 11404	Exc Bgn Lesion w/Margins 11404	Surgery	11404	CPT	2726350		Washington Regional Medical Center	outpatient	2366	1183	WellCare of North Carolina	North Carolina Medicaid/CHIP	831.89	158.69	1774.5
Exc Bgn Lesion w/Margins 11404	Exc Bgn Lesion w/Margins 11404	Surgery	11404	CPT	2726350		Washington Regional Medical Center	outpatient	2366	1183	Healthy Blue / Blue Cross NC	North Carolina Medicaid	831.89	158.69	1774.5
Exc Bgn Lesion w/Margins 11404	Exc Bgn Lesion w/Margins 11404	Surgery	11404	CPT	2726350		Washington Regional Medical Center	outpatient	2366	1183	Cigna	North Carolina PPO-PPA Direct	158.69	158.69	1774.5
Exc Bgn Lesion w/Margins 11404	Exc Bgn Lesion w/Margins 11404	Surgery	11404	CPT	2726350		Washington Regional Medical Center	outpatient	2366	1183	Original Medicare	Traditional Medicare Fee-for-Service	1112.02	158.69	1774.5
Exc Bgn Lesn w/Margins 11426	Exc Bgn Lesn w/Margins 11426	Surgery	11426	CPT	5018190		Washington Regional Medical Center	outpatient	3801	1900.5	Self-Pay	Discounted Cash		272.01	2850.75
Exc Bgn Lesn w/Margins 11426	Exc Bgn Lesn w/Margins 11426	Surgery	11426	CPT	5018190		Washington Regional Medical Center	outpatient	3801	1900.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	2850.75	272.01	2850.75
Exc Bgn Lesn w/Margins 11426	Exc Bgn Lesn w/Margins 11426	Surgery	11426	CPT	5018190		Washington Regional Medical Center	outpatient	3801	1900.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	1672.44	272.01	2850.75
Exc Bgn Lesn w/Margins 11426	Exc Bgn Lesn w/Margins 11426	Surgery	11426	CPT	5018190		Washington Regional Medical Center	outpatient	3801	1900.5	Humana	Medicare Advantage HMO/PPO/PFFS	1786.47	272.01	2850.75
Exc Bgn Lesn w/Margins 11426	Exc Bgn Lesn w/Margins 11426	Surgery	11426	CPT	5018190		Washington Regional Medical Center	outpatient	3801	1900.5	AmeriHealth Caritas North Carolina	NC Medicaid	1336.43	272.01	2850.75
Exc Bgn Lesn w/Margins 11426	Exc Bgn Lesn w/Margins 11426	Surgery	11426	CPT	5018190		Washington Regional Medical Center	outpatient	3801	1900.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	1336.43	272.01	2850.75
Exc Bgn Lesn w/Margins 11426	Exc Bgn Lesn w/Margins 11426	Surgery	11426	CPT	5018190		Washington Regional Medical Center	outpatient	3801	1900.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	1336.43	272.01	2850.75
Exc Bgn Lesn w/Margins 11426	Exc Bgn Lesn w/Margins 11426	Surgery	11426	CPT	5018190		Washington Regional Medical Center	outpatient	3801	1900.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	1336.43	272.01	2850.75
Exc Bgn Lesn w/Margins 11426	Exc Bgn Lesn w/Margins 11426	Surgery	11426	CPT	5018190		Washington Regional Medical Center	outpatient	3801	1900.5	Cigna	North Carolina PPO-PPA Direct	272.01	272.01	2850.75
Exc Bgn Lesn w/Margins 11426	Exc Bgn Lesn w/Margins 11426	Surgery	11426	CPT	5018190		Washington Regional Medical Center	outpatient	3801	1900.5	Original Medicare	Traditional Medicare Fee-for-Service	1786.47	272.01	2850.75
Exc Mal Lesion w/ Margin 11602	Exc Mal Lesion w/ Margin 11602	Surgery	11602	CPT	2726359		Washington Regional Medical Center	outpatient	594	297	Self-Pay	Discounted Cash		145.47	445.5
Exc Mal Lesion w/ Margin 11602	Exc Mal Lesion w/ Margin 11602	Surgery	11602	CPT	2726359		Washington Regional Medical Center	outpatient	594	297	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	445.5	145.47	445.5
Exc Mal Lesion w/ Margin 11602	Exc Mal Lesion w/ Margin 11602	Surgery	11602	CPT	2726359		Washington Regional Medical Center	outpatient	594	297	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	261.36	145.47	445.5
Exc Mal Lesion w/ Margin 11602	Exc Mal Lesion w/ Margin 11602	Surgery	11602	CPT	2726359		Washington Regional Medical Center	outpatient	594	297	Humana	Medicare Advantage HMO/PPO/PFFS	279.18	145.47	445.5
Exc Mal Lesion w/ Margin 11602	Exc Mal Lesion w/ Margin 11602	Surgery	11602	CPT	2726359		Washington Regional Medical Center	outpatient	594	297	AmeriHealth Caritas North Carolina	NC Medicaid	208.85	145.47	445.5
Exc Mal Lesion w/ Margin 11602	Exc Mal Lesion w/ Margin 11602	Surgery	11602	CPT	2726359		Washington Regional Medical Center	outpatient	594	297	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	208.85	145.47	445.5
Exc Mal Lesion w/ Margin 11602	Exc Mal Lesion w/ Margin 11602	Surgery	11602	CPT	2726359		Washington Regional Medical Center	outpatient	594	297	WellCare of North Carolina	North Carolina Medicaid/CHIP	208.85	145.47	445.5
Exc Mal Lesion w/ Margin 11602	Exc Mal Lesion w/ Margin 11602	Surgery	11602	CPT	2726359		Washington Regional Medical Center	outpatient	594	297	Healthy Blue / Blue Cross NC	North Carolina Medicaid	208.85	145.47	445.5
Exc Mal Lesion w/ Margin 11602	Exc Mal Lesion w/ Margin 11602	Surgery	11602	CPT	2726359		Washington Regional Medical Center	outpatient	594	297	Cigna	North Carolina PPO-PPA Direct	145.47	145.47	445.5
Exc Mal Lesion w/ Margin 11602	Exc Mal Lesion w/ Margin 11602	Surgery	11602	CPT	2726359		Washington Regional Medical Center	outpatient	594	297	Original Medicare	Traditional Medicare Fee-for-Service	279.18	145.47	445.5
Exc Mal Lesion w/ Margin 11643	Exc Mal Lesion w/ Margin 11643	Surgery	11643	CPT	2726366		Washington Regional Medical Center	outpatient	622	311	Self-Pay	Discounted Cash		218.7	466.5
Exc Mal Lesion w/ Margin 11643	Exc Mal Lesion w/ Margin 11643	Surgery	11643	CPT	2726366		Washington Regional Medical Center	outpatient	622	311	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	466.5	218.7	466.5
Exc Mal Lesion w/ Margin 11643	Exc Mal Lesion w/ Margin 11643	Surgery	11643	CPT	2726366		Washington Regional Medical Center	outpatient	622	311	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	273.68	218.7	466.5
Exc Mal Lesion w/ Margin 11643	Exc Mal Lesion w/ Margin 11643	Surgery	11643	CPT	2726366		Washington Regional Medical Center	outpatient	622	311	Humana	Medicare Advantage HMO/PPO/PFFS	292.34	218.7	466.5
Exc Mal Lesion w/ Margin 11643	Exc Mal Lesion w/ Margin 11643	Surgery	11643	CPT	2726366		Washington Regional Medical Center	outpatient	622	311	AmeriHealth Caritas North Carolina	NC Medicaid	218.7	218.7	466.5
Exc Mal Lesion w/ Margin 11643	Exc Mal Lesion w/ Margin 11643	Surgery	11643	CPT	2726366		Washington Regional Medical Center	outpatient	622	311	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	218.7	218.7	466.5
Exc Mal Lesion w/ Margin 11643	Exc Mal Lesion w/ Margin 11643	Surgery	11643	CPT	2726366		Washington Regional Medical Center	outpatient	622	311	WellCare of North Carolina	North Carolina Medicaid/CHIP	218.7	218.7	466.5
Exc Mal Lesion w/ Margin 11643	Exc Mal Lesion w/ Margin 11643	Surgery	11643	CPT	2726366		Washington Regional Medical Center	outpatient	622	311	Healthy Blue / Blue Cross NC	North Carolina Medicaid	218.7	218.7	466.5
Exc Mal Lesion w/ Margin 11643	Exc Mal Lesion w/ Margin 11643	Surgery	11643	CPT	2726366		Washington Regional Medical Center	outpatient	622	311	Cigna	North Carolina PPO-PPA Direct	230.7	218.7	466.5
Exc Mal Lesion w/ Margin 11643	Exc Mal Lesion w/ Margin 11643	Surgery	11643	CPT	2726366		Washington Regional Medical Center	outpatient	622	311	Original Medicare	Traditional Medicare Fee-for-Service	292.34	218.7	466.5
EXC MALIG LESN 1.1-2.0CM	EXC MALIG LESN 1.1-2.0CM	Surgery	11602	CPT	6001049		Washington Regional Medical Center	outpatient	500	250	Self-Pay	Discounted Cash		145.47	375
EXC MALIG LESN 1.1-2.0CM	EXC MALIG LESN 1.1-2.0CM	Surgery	11602	CPT	6001049		Washington Regional Medical Center	outpatient	500	250	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	375	145.47	375
EXC MALIG LESN 1.1-2.0CM	EXC MALIG LESN 1.1-2.0CM	Surgery	11602	CPT	6001049		Washington Regional Medical Center	outpatient	500	250	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	220	145.47	375
EXC MALIG LESN 1.1-2.0CM	EXC MALIG LESN 1.1-2.0CM	Surgery	11602	CPT	6001049		Washington Regional Medical Center	outpatient	500	250	Humana	Medicare Advantage HMO/PPO/PFFS	235	145.47	375
EXC MALIG LESN 1.1-2.0CM	EXC MALIG LESN 1.1-2.0CM	Surgery	11602	CPT	6001049		Washington Regional Medical Center	outpatient	500	250	AmeriHealth Caritas North Carolina	NC Medicaid	175.8	145.47	375
EXC MALIG LESN 1.1-2.0CM	EXC MALIG LESN 1.1-2.0CM	Surgery	11602	CPT	6001049		Washington Regional Medical Center	outpatient	500	250	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	175.8	145.47	375
EXC MALIG LESN 1.1-2.0CM	EXC MALIG LESN 1.1-2.0CM	Surgery	11602	CPT	6001049		Washington Regional Medical Center	outpatient	500	250	WellCare of North Carolina	North Carolina Medicaid/CHIP	175.8	145.47	375
EXC MALIG LESN 1.1-2.0CM	EXC MALIG LESN 1.1-2.0CM	Surgery	11602	CPT	6001049		Washington Regional Medical Center	outpatient	500	250	Healthy Blue / Blue Cross NC	North Carolina Medicaid	175.8	145.47	375
EXC MALIG LESN 1.1-2.0CM	EXC MALIG LESN 1.1-2.0CM	Surgery	11602	CPT	6001049		Washington Regional Medical Center	outpatient	500	250	Cigna	North Carolina PPO-PPA Direct	145.47	145.47	375
EXC MALIG LESN 1.1-2.0CM	EXC MALIG LESN 1.1-2.0CM	Surgery	11602	CPT	6001049		Washington Regional Medical Center	outpatient	500	250	Original Medicare	Traditional Medicare Fee-for-Service	235	145.47	375
EXC MALIG LESN TRNK/AR	EXC MALIG LESN TRNK/AR	Surgery	11602	CPT	7500437		Washington Regional Medical Center	outpatient	623.88	311.94	Self-Pay	Discounted Cash		145.47	467.91
EXC MALIG LESN TRNK/AR	EXC MALIG LESN TRNK/AR	Surgery	11602	CPT	7500437		Washington Regional Medical Center	outpatient	623.88	311.94	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	467.91	145.47	467.91
EXC MALIG LESN TRNK/AR	EXC MALIG LESN TRNK/AR	Surgery	11602	CPT	7500437		Washington Regional Medical Center	outpatient	623.88	311.94	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	274.51	145.47	467.91
EXC MALIG LESN TRNK/AR	EXC MALIG LESN TRNK/AR	Surgery	11602	CPT	7500437		Washington Regional Medical Center	outpatient	623.88	311.94	Humana	Medicare Advantage HMO/PPO/PFFS	293.22	145.47	467.91
EXC MALIG LESN TRNK/AR	EXC MALIG LESN TRNK/AR	Surgery	11602	CPT	7500437		Washington Regional Medical Center	outpatient	623.88	311.94	AmeriHealth Caritas North Carolina	NC Medicaid	219.36	145.47	467.91
EXC MALIG LESN TRNK/AR	EXC MALIG LESN TRNK/AR	Surgery	11602	CPT	7500437		Washington Regional Medical Center	outpatient	623.88	311.94	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	219.36	145.47	467.91
EXC MALIG LESN TRNK/AR	EXC MALIG LESN TRNK/AR	Surgery	11602	CPT	7500437		Washington Regional Medical Center	outpatient	623.88	311.94	WellCare of North Carolina	North Carolina Medicaid/CHIP	219.36	145.47	467.91
EXC MALIG LESN TRNK/AR	EXC MALIG LESN TRNK/AR	Surgery	11602	CPT	7500437		Washington Regional Medical Center	outpatient	623.88	311.94	Healthy Blue / Blue Cross NC	North Carolina Medicaid	219.36	145.47	467.91
EXC MALIG LESN TRNK/AR	EXC MALIG LESN TRNK/AR	Surgery	11602	CPT	7500437		Washington Regional Medical Center	outpatient	623.88	311.94	Cigna	North Carolina PPO-PPA Direct	145.47	145.47	467.91
EXC MALIG LESN TRNK/AR	EXC MALIG LESN TRNK/AR	Surgery	11602	CPT	7500437		Washington Regional Medical Center	outpatient	623.88	311.94	Original Medicare	Traditional Medicare Fee-for-Service	293.22	145.47	467.91
Exc Nail & Mtrx Partl/cp 11750	Exc Nail & Mtrx Partl/cp 11750	Surgery	11750	CPT	1021843		Washington Regional Medical Center	outpatient	642	321	Self-Pay	Discounted Cash		164.61	481.5
Exc Nail & Mtrx Partl/cp 11750	Exc Nail & Mtrx Partl/cp 11750	Surgery	11750	CPT	1021843		Washington Regional Medical Center	outpatient	642	321	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	481.5	164.61	481.5
Exc Nail & Mtrx Partl/cp 11750	Exc Nail & Mtrx Partl/cp 11750	Surgery	11750	CPT	1021843		Washington Regional Medical Center	outpatient	642	321	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	282.48	164.61	481.5
Exc Nail & Mtrx Partl/cp 11750	Exc Nail & Mtrx Partl/cp 11750	Surgery	11750	CPT	1021843		Washington Regional Medical Center	outpatient	642	321	Humana	Medicare Advantage HMO/PPO/PFFS	301.74	164.61	481.5
Exc Nail & Mtrx Partl/cp 11750	Exc Nail & Mtrx Partl/cp 11750	Surgery	11750	CPT	1021843		Washington Regional Medical Center	outpatient	642	321	AmeriHealth Caritas North Carolina	NC Medicaid	225.73	164.61	481.5
Exc Nail & Mtrx Partl/cp 11750	Exc Nail & Mtrx Partl/cp 11750	Surgery	11750	CPT	1021843		Washington Regional Medical Center	outpatient	642	321	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	225.73	164.61	481.5
Exc Nail & Mtrx Partl/cp 11750	Exc Nail & Mtrx Partl/cp 11750	Surgery	11750	CPT	1021843		Washington Regional Medical Center	outpatient	642	321	WellCare of North Carolina	North Carolina Medicaid/CHIP	225.73	164.61	481.5
Exc Nail & Mtrx Partl/cp 11750	Exc Nail & Mtrx Partl/cp 11750	Surgery	11750	CPT	1021843		Washington Regional Medical Center	outpatient	642	321	Healthy Blue / Blue Cross NC	North Carolina Medicaid	225.73	164.61	481.5
Exc Nail & Mtrx Partl/cp 11750	Exc Nail & Mtrx Partl/cp 11750	Surgery	11750	CPT	1021843		Washington Regional Medical Center	outpatient	642	321	Cigna	North Carolina PPO-PPA Direct	164.61	164.61	481.5
Exc Nail & Mtrx Partl/cp 11750	Exc Nail & Mtrx Partl/cp 11750	Surgery	11750	CPT	1021843		Washington Regional Medical Center	outpatient	642	321	Original Medicare	Traditional Medicare Fee-for-Service	301.74	164.61	481.5
EXCISION NAIL AND NAIL MATRIX	EXCISION NAIL AND NAIL MATRIX	Surgery	11750	CPT	6001174		Washington Regional Medical Center	outpatient	642	321	Self-Pay	Discounted Cash		164.61	481.5
EXCISION NAIL AND NAIL MATRIX	EXCISION NAIL AND NAIL MATRIX	Surgery	11750	CPT	6001174		Washington Regional Medical Center	outpatient	642	321	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	481.5	164.61	481.5
EXCISION NAIL AND NAIL MATRIX	EXCISION NAIL AND NAIL MATRIX	Surgery	11750	CPT	6001174		Washington Regional Medical Center	outpatient	642	321	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	282.48	164.61	481.5
EXCISION NAIL AND NAIL MATRIX	EXCISION NAIL AND NAIL MATRIX	Surgery	11750	CPT	6001174		Washington Regional Medical Center	outpatient	642	321	Humana	Medicare Advantage HMO/PPO/PFFS	301.74	164.61	481.5
EXCISION NAIL AND NAIL MATRIX	EXCISION NAIL AND NAIL MATRIX	Surgery	11750	CPT	6001174		Washington Regional Medical Center	outpatient	642	321	AmeriHealth Caritas North Carolina	NC Medicaid	225.73	164.61	481.5
EXCISION NAIL AND NAIL MATRIX	EXCISION NAIL AND NAIL MATRIX	Surgery	11750	CPT	6001174		Washington Regional Medical Center	outpatient	642	321	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	225.73	164.61	481.5
EXCISION NAIL AND NAIL MATRIX	EXCISION NAIL AND NAIL MATRIX	Surgery	11750	CPT	6001174		Washington Regional Medical Center	outpatient	642	321	WellCare of North Carolina	North Carolina Medicaid/CHIP	225.73	164.61	481.5
EXCISION NAIL AND NAIL MATRIX	EXCISION NAIL AND NAIL MATRIX	Surgery	11750	CPT	6001174		Washington Regional Medical Center	outpatient	642	321	Healthy Blue / Blue Cross NC	North Carolina Medicaid	225.73	164.61	481.5
EXCISION NAIL AND NAIL MATRIX	EXCISION NAIL AND NAIL MATRIX	Surgery	11750	CPT	6001174		Washington Regional Medical Center	outpatient	642	321	Cigna	North Carolina PPO-PPA Direct	164.61	164.61	481.5
EXCISION NAIL AND NAIL MATRIX	EXCISION NAIL AND NAIL MATRIX	Surgery	11750	CPT	6001174		Washington Regional Medical Center	outpatient	642	321	Original Medicare	Traditional Medicare Fee-for-Service	301.74	164.61	481.5
EXCISION NAIL AND NAIL MATRIX	EXCISION NAIL AND NAIL MATRIX	Surgery	11750	CPT	7501054		Washington Regional Medical Center	outpatient	475	237.5	Self-Pay	Discounted Cash		164.61	356.25
EXCISION NAIL AND NAIL MATRIX	EXCISION NAIL AND NAIL MATRIX	Surgery	11750	CPT	7501054		Washington Regional Medical Center	outpatient	475	237.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	356.25	164.61	356.25
EXCISION NAIL AND NAIL MATRIX	EXCISION NAIL AND NAIL MATRIX	Surgery	11750	CPT	7501054		Washington Regional Medical Center	outpatient	475	237.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	209	164.61	356.25
EXCISION NAIL AND NAIL MATRIX	EXCISION NAIL AND NAIL MATRIX	Surgery	11750	CPT	7501054		Washington Regional Medical Center	outpatient	475	237.5	Humana	Medicare Advantage HMO/PPO/PFFS	223.25	164.61	356.25
EXCISION NAIL AND NAIL MATRIX	EXCISION NAIL AND NAIL MATRIX	Surgery	11750	CPT	7501054		Washington Regional Medical Center	outpatient	475	237.5	AmeriHealth Caritas North Carolina	NC Medicaid	167.01	164.61	356.25
EXCISION NAIL AND NAIL MATRIX	EXCISION NAIL AND NAIL MATRIX	Surgery	11750	CPT	7501054		Washington Regional Medical Center	outpatient	475	237.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	167.01	164.61	356.25
EXCISION NAIL AND NAIL MATRIX	EXCISION NAIL AND NAIL MATRIX	Surgery	11750	CPT	7501054		Washington Regional Medical Center	outpatient	475	237.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	167.01	164.61	356.25
EXCISION NAIL AND NAIL MATRIX	EXCISION NAIL AND NAIL MATRIX	Surgery	11750	CPT	7501054		Washington Regional Medical Center	outpatient	475	237.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	167.01	164.61	356.25
EXCISION NAIL AND NAIL MATRIX	EXCISION NAIL AND NAIL MATRIX	Surgery	11750	CPT	7501054		Washington Regional Medical Center	outpatient	475	237.5	Cigna	North Carolina PPO-PPA Direct	164.61	164.61	356.25
EXCISION NAIL AND NAIL MATRIX	EXCISION NAIL AND NAIL MATRIX	Surgery	11750	CPT	7501054		Washington Regional Medical Center	outpatient	475	237.5	Original Medicare	Traditional Medicare Fee-for-Service	223.25	164.61	356.25
EXCISION THROMBOSED HEM	EXCISION THROMBOSED HEM	Surgery	46320	CPT	7599339		Washington Regional Medical Center	outpatient	554	277	Self-Pay	Discounted Cash		114.21	415.5
EXCISION THROMBOSED HEM	EXCISION THROMBOSED HEM	Surgery	46320	CPT	7599339		Washington Regional Medical Center	outpatient	554	277	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	415.5	114.21	415.5
EXCISION THROMBOSED HEM	EXCISION THROMBOSED HEM	Surgery	46320	CPT	7599339		Washington Regional Medical Center	outpatient	554	277	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	243.76	114.21	415.5
EXCISION THROMBOSED HEM	EXCISION THROMBOSED HEM	Surgery	46320	CPT	7599339		Washington Regional Medical Center	outpatient	554	277	Humana	Medicare Advantage HMO/PPO/PFFS	260.38	114.21	415.5
EXCISION THROMBOSED HEM	EXCISION THROMBOSED HEM	Surgery	46320	CPT	7599339		Washington Regional Medical Center	outpatient	554	277	AmeriHealth Caritas North Carolina	NC Medicaid	194.79	114.21	415.5
EXCISION THROMBOSED HEM	EXCISION THROMBOSED HEM	Surgery	46320	CPT	7599339		Washington Regional Medical Center	outpatient	554	277	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	194.79	114.21	415.5
EXCISION THROMBOSED HEM	EXCISION THROMBOSED HEM	Surgery	46320	CPT	7599339		Washington Regional Medical Center	outpatient	554	277	WellCare of North Carolina	North Carolina Medicaid/CHIP	194.79	114.21	415.5
EXCISION THROMBOSED HEM	EXCISION THROMBOSED HEM	Surgery	46320	CPT	7599339		Washington Regional Medical Center	outpatient	554	277	Healthy Blue / Blue Cross NC	North Carolina Medicaid	194.79	114.21	415.5
EXCISION THROMBOSED HEM	EXCISION THROMBOSED HEM	Surgery	46320	CPT	7599339		Washington Regional Medical Center	outpatient	554	277	Cigna	North Carolina PPO-PPA Direct	114.21	114.21	415.5
EXCISION THROMBOSED HEM	EXCISION THROMBOSED HEM	Surgery	46320	CPT	7599339		Washington Regional Medical Center	outpatient	554	277	Original Medicare	Traditional Medicare Fee-for-Service	260.38	114.21	415.5
EXCISION THROMBOSED HEMOS	EXCISION THROMBOSED HEMOS	Surgery	46320	CPT	6001597		Washington Regional Medical Center	outpatient	554	277	Self-Pay	Discounted Cash		114.21	415.5
EXCISION THROMBOSED HEMOS	EXCISION THROMBOSED HEMOS	Surgery	46320	CPT	6001597		Washington Regional Medical Center	outpatient	554	277	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	415.5	114.21	415.5
EXCISION THROMBOSED HEMOS	EXCISION THROMBOSED HEMOS	Surgery	46320	CPT	6001597		Washington Regional Medical Center	outpatient	554	277	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	243.76	114.21	415.5
EXCISION THROMBOSED HEMOS	EXCISION THROMBOSED HEMOS	Surgery	46320	CPT	6001597		Washington Regional Medical Center	outpatient	554	277	Humana	Medicare Advantage HMO/PPO/PFFS	260.38	114.21	415.5
EXCISION THROMBOSED HEMOS	EXCISION THROMBOSED HEMOS	Surgery	46320	CPT	6001597		Washington Regional Medical Center	outpatient	554	277	AmeriHealth Caritas North Carolina	NC Medicaid	194.79	114.21	415.5
EXCISION THROMBOSED HEMOS	EXCISION THROMBOSED HEMOS	Surgery	46320	CPT	6001597		Washington Regional Medical Center	outpatient	554	277	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	194.79	114.21	415.5
EXCISION THROMBOSED HEMOS	EXCISION THROMBOSED HEMOS	Surgery	46320	CPT	6001597		Washington Regional Medical Center	outpatient	554	277	WellCare of North Carolina	North Carolina Medicaid/CHIP	194.79	114.21	415.5
EXCISION THROMBOSED HEMOS	EXCISION THROMBOSED HEMOS	Surgery	46320	CPT	6001597		Washington Regional Medical Center	outpatient	554	277	Healthy Blue / Blue Cross NC	North Carolina Medicaid	194.79	114.21	415.5
EXCISION THROMBOSED HEMOS	EXCISION THROMBOSED HEMOS	Surgery	46320	CPT	6001597		Washington Regional Medical Center	outpatient	554	277	Cigna	North Carolina PPO-PPA Direct	114.21	114.21	415.5
EXCISION THROMBOSED HEMOS	EXCISION THROMBOSED HEMOS	Surgery	46320	CPT	6001597		Washington Regional Medical Center	outpatient	554	277	Original Medicare	Traditional Medicare Fee-for-Service	260.38	114.21	415.5
FB REM- MOUTH	FB REM- MOUTH	Surgery	42970	CPT	6001590		Washington Regional Medical Center	outpatient	648.21	324.11	Self-Pay	Discounted Cash		227.91	486.16
FB REM- MOUTH	FB REM- MOUTH	Surgery	42970	CPT	6001590		Washington Regional Medical Center	outpatient	648.21	324.11	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	486.16	227.91	486.16
FB REM- MOUTH	FB REM- MOUTH	Surgery	42970	CPT	6001590		Washington Regional Medical Center	outpatient	648.21	324.11	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	285.21	227.91	486.16
FB REM- MOUTH	FB REM- MOUTH	Surgery	42970	CPT	6001590		Washington Regional Medical Center	outpatient	648.21	324.11	Humana	Medicare Advantage HMO/PPO/PFFS	304.66	227.91	486.16
FB REM- MOUTH	FB REM- MOUTH	Surgery	42970	CPT	6001590		Washington Regional Medical Center	outpatient	648.21	324.11	AmeriHealth Caritas North Carolina	NC Medicaid	227.91	227.91	486.16
FB REM- MOUTH	FB REM- MOUTH	Surgery	42970	CPT	6001590		Washington Regional Medical Center	outpatient	648.21	324.11	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	227.91	227.91	486.16
FB REM- MOUTH	FB REM- MOUTH	Surgery	42970	CPT	6001590		Washington Regional Medical Center	outpatient	648.21	324.11	WellCare of North Carolina	North Carolina Medicaid/CHIP	227.91	227.91	486.16
FB REM- MOUTH	FB REM- MOUTH	Surgery	42970	CPT	6001590		Washington Regional Medical Center	outpatient	648.21	324.11	Healthy Blue / Blue Cross NC	North Carolina Medicaid	227.91	227.91	486.16
FB REM- MOUTH	FB REM- MOUTH	Surgery	42970	CPT	6001590		Washington Regional Medical Center	outpatient	648.21	324.11	Cigna	North Carolina PPO-PPA Direct	433.67	227.91	486.16
FB REM- MOUTH	FB REM- MOUTH	Surgery	42970	CPT	6001590		Washington Regional Medical Center	outpatient	648.21	324.11	Original Medicare	Traditional Medicare Fee-for-Service	304.66	227.91	486.16
FB REMOVAL SQ TIS SIMPLE	FB REMOVAL SQ TIS SIMPLE	Surgery	10121	CPT	7501028		Washington Regional Medical Center	outpatient	489	244.5	Self-Pay	Discounted Cash		171.93	366.75
FB REMOVAL SQ TIS SIMPLE	FB REMOVAL SQ TIS SIMPLE	Surgery	10121	CPT	7501028		Washington Regional Medical Center	outpatient	489	244.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	366.75	171.93	366.75
FB REMOVAL SQ TIS SIMPLE	FB REMOVAL SQ TIS SIMPLE	Surgery	10121	CPT	7501028		Washington Regional Medical Center	outpatient	489	244.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	215.16	171.93	366.75
FB REMOVAL SQ TIS SIMPLE	FB REMOVAL SQ TIS SIMPLE	Surgery	10121	CPT	7501028		Washington Regional Medical Center	outpatient	489	244.5	Humana	Medicare Advantage HMO/PPO/PFFS	229.83	171.93	366.75
FB REMOVAL SQ TIS SIMPLE	FB REMOVAL SQ TIS SIMPLE	Surgery	10121	CPT	7501028		Washington Regional Medical Center	outpatient	489	244.5	AmeriHealth Caritas North Carolina	NC Medicaid	171.93	171.93	366.75
FB REMOVAL SQ TIS SIMPLE	FB REMOVAL SQ TIS SIMPLE	Surgery	10121	CPT	7501028		Washington Regional Medical Center	outpatient	489	244.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	171.93	171.93	366.75
FB REMOVAL SQ TIS SIMPLE	FB REMOVAL SQ TIS SIMPLE	Surgery	10121	CPT	7501028		Washington Regional Medical Center	outpatient	489	244.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	171.93	171.93	366.75
FB REMOVAL SQ TIS SIMPLE	FB REMOVAL SQ TIS SIMPLE	Surgery	10121	CPT	7501028		Washington Regional Medical Center	outpatient	489	244.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	171.93	171.93	366.75
FB REMOVAL SQ TIS SIMPLE	FB REMOVAL SQ TIS SIMPLE	Surgery	10121	CPT	7501028		Washington Regional Medical Center	outpatient	489	244.5	Cigna	North Carolina PPO-PPA Direct	206.52	171.93	366.75
FB REMOVAL SQ TIS SIMPLE	FB REMOVAL SQ TIS SIMPLE	Surgery	10121	CPT	7501028		Washington Regional Medical Center	outpatient	489	244.5	Original Medicare	Traditional Medicare Fee-for-Service	229.83	171.93	366.75
FNA Bx w/o Im Gd Add Les 10004	FNA Bx w/o Im Gd Add Les 10004	Surgery	10004	CPT	10332965		Washington Regional Medical Center	outpatient	290	145	Self-Pay	Discounted Cash		53.89	217.5
FNA Bx w/o Im Gd Add Les 10004	FNA Bx w/o Im Gd Add Les 10004	Surgery	10004	CPT	10332965		Washington Regional Medical Center	outpatient	290	145	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	217.5	53.89	217.5
FNA Bx w/o Im Gd Add Les 10004	FNA Bx w/o Im Gd Add Les 10004	Surgery	10004	CPT	10332965		Washington Regional Medical Center	outpatient	290	145	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	127.6	53.89	217.5
FNA Bx w/o Im Gd Add Les 10004	FNA Bx w/o Im Gd Add Les 10004	Surgery	10004	CPT	10332965		Washington Regional Medical Center	outpatient	290	145	Humana	Medicare Advantage HMO/PPO/PFFS	136.3	53.89	217.5
FNA Bx w/o Im Gd Add Les 10004	FNA Bx w/o Im Gd Add Les 10004	Surgery	10004	CPT	10332965		Washington Regional Medical Center	outpatient	290	145	AmeriHealth Caritas North Carolina	NC Medicaid	101.96	53.89	217.5
FNA Bx w/o Im Gd Add Les 10004	FNA Bx w/o Im Gd Add Les 10004	Surgery	10004	CPT	10332965		Washington Regional Medical Center	outpatient	290	145	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	101.96	53.89	217.5
FNA Bx w/o Im Gd Add Les 10004	FNA Bx w/o Im Gd Add Les 10004	Surgery	10004	CPT	10332965		Washington Regional Medical Center	outpatient	290	145	WellCare of North Carolina	North Carolina Medicaid/CHIP	101.96	53.89	217.5
FNA Bx w/o Im Gd Add Les 10004	FNA Bx w/o Im Gd Add Les 10004	Surgery	10004	CPT	10332965		Washington Regional Medical Center	outpatient	290	145	Healthy Blue / Blue Cross NC	North Carolina Medicaid	101.96	53.89	217.5
FNA Bx w/o Im Gd Add Les 10004	FNA Bx w/o Im Gd Add Les 10004	Surgery	10004	CPT	10332965		Washington Regional Medical Center	outpatient	290	145	Cigna	North Carolina PPO-PPA Direct	53.89	53.89	217.5
FNA Bx w/o Im Gd Add Les 10004	FNA Bx w/o Im Gd Add Les 10004	Surgery	10004	CPT	10332965		Washington Regional Medical Center	outpatient	290	145	Original Medicare	Traditional Medicare Fee-for-Service	136.3	53.89	217.5
Freskn Manip w/Lys Prept 54450	Freskn Manip w/Lys Prept 54450	Surgery	54450	CPT	8078336		Washington Regional Medical Center	outpatient	176	88	Self-Pay	Discounted Cash		61.88	132
Freskn Manip w/Lys Prept 54450	Freskn Manip w/Lys Prept 54450	Surgery	54450	CPT	8078336		Washington Regional Medical Center	outpatient	176	88	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	132	61.88	132
Freskn Manip w/Lys Prept 54450	Freskn Manip w/Lys Prept 54450	Surgery	54450	CPT	8078336		Washington Regional Medical Center	outpatient	176	88	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	77.44	61.88	132
Freskn Manip w/Lys Prept 54450	Freskn Manip w/Lys Prept 54450	Surgery	54450	CPT	8078336		Washington Regional Medical Center	outpatient	176	88	Humana	Medicare Advantage HMO/PPO/PFFS	82.72	61.88	132
Freskn Manip w/Lys Prept 54450	Freskn Manip w/Lys Prept 54450	Surgery	54450	CPT	8078336		Washington Regional Medical Center	outpatient	176	88	AmeriHealth Caritas North Carolina	NC Medicaid	61.88	61.88	132
Freskn Manip w/Lys Prept 54450	Freskn Manip w/Lys Prept 54450	Surgery	54450	CPT	8078336		Washington Regional Medical Center	outpatient	176	88	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	61.88	61.88	132
Freskn Manip w/Lys Prept 54450	Freskn Manip w/Lys Prept 54450	Surgery	54450	CPT	8078336		Washington Regional Medical Center	outpatient	176	88	WellCare of North Carolina	North Carolina Medicaid/CHIP	61.88	61.88	132
Freskn Manip w/Lys Prept 54450	Freskn Manip w/Lys Prept 54450	Surgery	54450	CPT	8078336		Washington Regional Medical Center	outpatient	176	88	Healthy Blue / Blue Cross NC	North Carolina Medicaid	61.88	61.88	132
Freskn Manip w/Lys Prept 54450	Freskn Manip w/Lys Prept 54450	Surgery	54450	CPT	8078336		Washington Regional Medical Center	outpatient	176	88	Cigna	North Carolina PPO-PPA Direct	71.77	61.88	132
Freskn Manip w/Lys Prept 54450	Freskn Manip w/Lys Prept 54450	Surgery	54450	CPT	8078336		Washington Regional Medical Center	outpatient	176	88	Original Medicare	Traditional Medicare Fee-for-Service	82.72	61.88	132
Inj AnsAgnt Pudendal Nrv 64430	Inj AnsAgnt Pudendal Nrv 64430	Surgery	64430	CPT	10600998		Washington Regional Medical Center	outpatient	212.56	106.28	Self-Pay	Discounted Cash		74.74	159.42
Inj AnsAgnt Pudendal Nrv 64430	Inj AnsAgnt Pudendal Nrv 64430	Surgery	64430	CPT	10600998		Washington Regional Medical Center	outpatient	212.56	106.28	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	159.42	74.74	159.42
Inj AnsAgnt Pudendal Nrv 64430	Inj AnsAgnt Pudendal Nrv 64430	Surgery	64430	CPT	10600998		Washington Regional Medical Center	outpatient	212.56	106.28	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	93.53	74.74	159.42
Inj AnsAgnt Pudendal Nrv 64430	Inj AnsAgnt Pudendal Nrv 64430	Surgery	64430	CPT	10600998		Washington Regional Medical Center	outpatient	212.56	106.28	Humana	Medicare Advantage HMO/PPO/PFFS	99.9	74.74	159.42
Inj AnsAgnt Pudendal Nrv 64430	Inj AnsAgnt Pudendal Nrv 64430	Surgery	64430	CPT	10600998		Washington Regional Medical Center	outpatient	212.56	106.28	AmeriHealth Caritas North Carolina	NC Medicaid	74.74	74.74	159.42
Inj AnsAgnt Pudendal Nrv 64430	Inj AnsAgnt Pudendal Nrv 64430	Surgery	64430	CPT	10600998		Washington Regional Medical Center	outpatient	212.56	106.28	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	74.74	74.74	159.42
Inj AnsAgnt Pudendal Nrv 64430	Inj AnsAgnt Pudendal Nrv 64430	Surgery	64430	CPT	10600998		Washington Regional Medical Center	outpatient	212.56	106.28	WellCare of North Carolina	North Carolina Medicaid/CHIP	74.74	74.74	159.42
Inj AnsAgnt Pudendal Nrv 64430	Inj AnsAgnt Pudendal Nrv 64430	Surgery	64430	CPT	10600998		Washington Regional Medical Center	outpatient	212.56	106.28	Healthy Blue / Blue Cross NC	North Carolina Medicaid	74.74	74.74	159.42
Inj AnsAgnt Pudendal Nrv 64430	Inj AnsAgnt Pudendal Nrv 64430	Surgery	64430	CPT	10600998		Washington Regional Medical Center	outpatient	212.56	106.28	Cigna	North Carolina PPO-PPA Direct	92.73	74.74	159.42
Inj AnsAgnt Pudendal Nrv 64430	Inj AnsAgnt Pudendal Nrv 64430	Surgery	64430	CPT	10600998		Washington Regional Medical Center	outpatient	212.56	106.28	Original Medicare	Traditional Medicare Fee-for-Service	99.9	74.74	159.42
INSERT NON-TUNNEL CENTRAL	INSERT NON-TUNNEL CENTRAL	Surgery	36556	CPT	7501135		Washington Regional Medical Center	outpatient	163	81.5	Self-Pay	Discounted Cash		57.31	150.35
INSERT NON-TUNNEL CENTRAL	INSERT NON-TUNNEL CENTRAL	Surgery	36556	CPT	7501135		Washington Regional Medical Center	outpatient	163	81.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	122.25	57.31	150.35
INSERT NON-TUNNEL CENTRAL	INSERT NON-TUNNEL CENTRAL	Surgery	36556	CPT	7501135		Washington Regional Medical Center	outpatient	163	81.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	71.72	57.31	150.35
INSERT NON-TUNNEL CENTRAL	INSERT NON-TUNNEL CENTRAL	Surgery	36556	CPT	7501135		Washington Regional Medical Center	outpatient	163	81.5	Humana	Medicare Advantage HMO/PPO/PFFS	76.61	57.31	150.35
INSERT NON-TUNNEL CENTRAL	INSERT NON-TUNNEL CENTRAL	Surgery	36556	CPT	7501135		Washington Regional Medical Center	outpatient	163	81.5	AmeriHealth Caritas North Carolina	NC Medicaid	57.31	57.31	150.35
INSERT NON-TUNNEL CENTRAL	INSERT NON-TUNNEL CENTRAL	Surgery	36556	CPT	7501135		Washington Regional Medical Center	outpatient	163	81.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	57.31	57.31	150.35
INSERT NON-TUNNEL CENTRAL	INSERT NON-TUNNEL CENTRAL	Surgery	36556	CPT	7501135		Washington Regional Medical Center	outpatient	163	81.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	57.31	57.31	150.35
INSERT NON-TUNNEL CENTRAL	INSERT NON-TUNNEL CENTRAL	Surgery	36556	CPT	7501135		Washington Regional Medical Center	outpatient	163	81.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	57.31	57.31	150.35
INSERT NON-TUNNEL CENTRAL	INSERT NON-TUNNEL CENTRAL	Surgery	36556	CPT	7501135		Washington Regional Medical Center	outpatient	163	81.5	Cigna	North Carolina PPO-PPA Direct	150.35	57.31	150.35
INSERT NON-TUNNEL CENTRAL	INSERT NON-TUNNEL CENTRAL	Surgery	36556	CPT	7501135		Washington Regional Medical Center	outpatient	163	81.5	Original Medicare	Traditional Medicare Fee-for-Service	76.61	57.31	150.35
INT Rp s/a/t/e 2.6-7.5cm 12032	INT Rp s/a/t/e 2.6-7.5cm 12032	Surgery	12032	CPT	1021860		Washington Regional Medical Center	outpatient	730.12	365.06	Self-Pay	Discounted Cash		192.57	547.59
INT Rp s/a/t/e 2.6-7.5cm 12032	INT Rp s/a/t/e 2.6-7.5cm 12032	Surgery	12032	CPT	1021860		Washington Regional Medical Center	outpatient	730.12	365.06	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	547.59	192.57	547.59
INT Rp s/a/t/e 2.6-7.5cm 12032	INT Rp s/a/t/e 2.6-7.5cm 12032	Surgery	12032	CPT	1021860		Washington Regional Medical Center	outpatient	730.12	365.06	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	321.25	192.57	547.59
INT Rp s/a/t/e 2.6-7.5cm 12032	INT Rp s/a/t/e 2.6-7.5cm 12032	Surgery	12032	CPT	1021860		Washington Regional Medical Center	outpatient	730.12	365.06	Humana	Medicare Advantage HMO/PPO/PFFS	343.16	192.57	547.59
INT Rp s/a/t/e 2.6-7.5cm 12032	INT Rp s/a/t/e 2.6-7.5cm 12032	Surgery	12032	CPT	1021860		Washington Regional Medical Center	outpatient	730.12	365.06	AmeriHealth Caritas North Carolina	NC Medicaid	256.71	192.57	547.59
INT Rp s/a/t/e 2.6-7.5cm 12032	INT Rp s/a/t/e 2.6-7.5cm 12032	Surgery	12032	CPT	1021860		Washington Regional Medical Center	outpatient	730.12	365.06	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	256.71	192.57	547.59
INT Rp s/a/t/e 2.6-7.5cm 12032	INT Rp s/a/t/e 2.6-7.5cm 12032	Surgery	12032	CPT	1021860		Washington Regional Medical Center	outpatient	730.12	365.06	WellCare of North Carolina	North Carolina Medicaid/CHIP	256.71	192.57	547.59
INT Rp s/a/t/e 2.6-7.5cm 12032	INT Rp s/a/t/e 2.6-7.5cm 12032	Surgery	12032	CPT	1021860		Washington Regional Medical Center	outpatient	730.12	365.06	Healthy Blue / Blue Cross NC	North Carolina Medicaid	256.71	192.57	547.59
INT Rp s/a/t/e 2.6-7.5cm 12032	INT Rp s/a/t/e 2.6-7.5cm 12032	Surgery	12032	CPT	1021860		Washington Regional Medical Center	outpatient	730.12	365.06	Cigna	North Carolina PPO-PPA Direct	192.57	192.57	547.59
INT Rp s/a/t/e 2.6-7.5cm 12032	INT Rp s/a/t/e 2.6-7.5cm 12032	Surgery	12032	CPT	1021860		Washington Regional Medical Center	outpatient	730.12	365.06	Original Medicare	Traditional Medicare Fee-for-Service	343.16	192.57	547.59
LAC COMPLEX 1.1-2.5CM	LAC COMPLEX 1.1-2.5CM	Surgery	13131	CPT	6001115		Washington Regional Medical Center	outpatient	1080	540	Self-Pay	Discounted Cash		292.79	810
LAC COMPLEX 1.1-2.5CM	LAC COMPLEX 1.1-2.5CM	Surgery	13131	CPT	6001115		Washington Regional Medical Center	outpatient	1080	540	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	810	292.79	810
LAC COMPLEX 1.1-2.5CM	LAC COMPLEX 1.1-2.5CM	Surgery	13131	CPT	6001115		Washington Regional Medical Center	outpatient	1080	540	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	475.2	292.79	810
LAC COMPLEX 1.1-2.5CM	LAC COMPLEX 1.1-2.5CM	Surgery	13131	CPT	6001115		Washington Regional Medical Center	outpatient	1080	540	Humana	Medicare Advantage HMO/PPO/PFFS	507.6	292.79	810
LAC COMPLEX 1.1-2.5CM	LAC COMPLEX 1.1-2.5CM	Surgery	13131	CPT	6001115		Washington Regional Medical Center	outpatient	1080	540	AmeriHealth Caritas North Carolina	NC Medicaid	379.73	292.79	810
LAC COMPLEX 1.1-2.5CM	LAC COMPLEX 1.1-2.5CM	Surgery	13131	CPT	6001115		Washington Regional Medical Center	outpatient	1080	540	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	379.73	292.79	810
LAC COMPLEX 1.1-2.5CM	LAC COMPLEX 1.1-2.5CM	Surgery	13131	CPT	6001115		Washington Regional Medical Center	outpatient	1080	540	WellCare of North Carolina	North Carolina Medicaid/CHIP	379.73	292.79	810
LAC COMPLEX 1.1-2.5CM	LAC COMPLEX 1.1-2.5CM	Surgery	13131	CPT	6001115		Washington Regional Medical Center	outpatient	1080	540	Healthy Blue / Blue Cross NC	North Carolina Medicaid	379.73	292.79	810
LAC COMPLEX 1.1-2.5CM	LAC COMPLEX 1.1-2.5CM	Surgery	13131	CPT	6001115		Washington Regional Medical Center	outpatient	1080	540	Cigna	North Carolina PPO-PPA Direct	292.79	292.79	810
LAC COMPLEX 1.1-2.5CM	LAC COMPLEX 1.1-2.5CM	Surgery	13131	CPT	6001115		Washington Regional Medical Center	outpatient	1080	540	Original Medicare	Traditional Medicare Fee-for-Service	507.6	292.79	810
LAC INT NECK/HAND/FT 7.6-12.5	LAC INT NECK/HAND/FT 7.6-12.5	Surgery	12044	CPT	6000047		Washington Regional Medical Center	outpatient	995	497.5	Self-Pay	Discounted Cash		218.54	746.25
LAC INT NECK/HAND/FT 7.6-12.5	LAC INT NECK/HAND/FT 7.6-12.5	Surgery	12044	CPT	6000047		Washington Regional Medical Center	outpatient	995	497.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	746.25	218.54	746.25
LAC INT NECK/HAND/FT 7.6-12.5	LAC INT NECK/HAND/FT 7.6-12.5	Surgery	12044	CPT	6000047		Washington Regional Medical Center	outpatient	995	497.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	437.8	218.54	746.25
LAC INT NECK/HAND/FT 7.6-12.5	LAC INT NECK/HAND/FT 7.6-12.5	Surgery	12044	CPT	6000047		Washington Regional Medical Center	outpatient	995	497.5	Humana	Medicare Advantage HMO/PPO/PFFS	467.65	218.54	746.25
LAC INT NECK/HAND/FT 7.6-12.5	LAC INT NECK/HAND/FT 7.6-12.5	Surgery	12044	CPT	6000047		Washington Regional Medical Center	outpatient	995	497.5	AmeriHealth Caritas North Carolina	NC Medicaid	349.84	218.54	746.25
LAC INT NECK/HAND/FT 7.6-12.5	LAC INT NECK/HAND/FT 7.6-12.5	Surgery	12044	CPT	6000047		Washington Regional Medical Center	outpatient	995	497.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	349.84	218.54	746.25
LAC INT NECK/HAND/FT 7.6-12.5	LAC INT NECK/HAND/FT 7.6-12.5	Surgery	12044	CPT	6000047		Washington Regional Medical Center	outpatient	995	497.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	349.84	218.54	746.25
LAC INT NECK/HAND/FT 7.6-12.5	LAC INT NECK/HAND/FT 7.6-12.5	Surgery	12044	CPT	6000047		Washington Regional Medical Center	outpatient	995	497.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	349.84	218.54	746.25
LAC INT NECK/HAND/FT 7.6-12.5	LAC INT NECK/HAND/FT 7.6-12.5	Surgery	12044	CPT	6000047		Washington Regional Medical Center	outpatient	995	497.5	Cigna	North Carolina PPO-PPA Direct	218.54	218.54	746.25
LAC INT NECK/HAND/FT 7.6-12.5	LAC INT NECK/HAND/FT 7.6-12.5	Surgery	12044	CPT	6000047		Washington Regional Medical Center	outpatient	995	497.5	Original Medicare	Traditional Medicare Fee-for-Service	467.65	218.54	746.25
LAC INTER SCLP/TK/EXT 2.6-7.5	LAC INTER SCLP/TK/EXT 2.6-7.5	Surgery	12032	CPT	7501036		Washington Regional Medical Center	outpatient	730.12	365.06	Self-Pay	Discounted Cash		192.57	547.59
LAC INTER SCLP/TK/EXT 2.6-7.5	LAC INTER SCLP/TK/EXT 2.6-7.5	Surgery	12032	CPT	7501036		Washington Regional Medical Center	outpatient	730.12	365.06	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	547.59	192.57	547.59
LAC INTER SCLP/TK/EXT 2.6-7.5	LAC INTER SCLP/TK/EXT 2.6-7.5	Surgery	12032	CPT	7501036		Washington Regional Medical Center	outpatient	730.12	365.06	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	321.25	192.57	547.59
LAC INTER SCLP/TK/EXT 2.6-7.5	LAC INTER SCLP/TK/EXT 2.6-7.5	Surgery	12032	CPT	7501036		Washington Regional Medical Center	outpatient	730.12	365.06	Humana	Medicare Advantage HMO/PPO/PFFS	343.16	192.57	547.59
LAC INTER SCLP/TK/EXT 2.6-7.5	LAC INTER SCLP/TK/EXT 2.6-7.5	Surgery	12032	CPT	7501036		Washington Regional Medical Center	outpatient	730.12	365.06	AmeriHealth Caritas North Carolina	NC Medicaid	256.71	192.57	547.59
LAC INTER SCLP/TK/EXT 2.6-7.5	LAC INTER SCLP/TK/EXT 2.6-7.5	Surgery	12032	CPT	7501036		Washington Regional Medical Center	outpatient	730.12	365.06	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	256.71	192.57	547.59
LAC INTER SCLP/TK/EXT 2.6-7.5	LAC INTER SCLP/TK/EXT 2.6-7.5	Surgery	12032	CPT	7501036		Washington Regional Medical Center	outpatient	730.12	365.06	WellCare of North Carolina	North Carolina Medicaid/CHIP	256.71	192.57	547.59
LAC INTER SCLP/TK/EXT 2.6-7.5	LAC INTER SCLP/TK/EXT 2.6-7.5	Surgery	12032	CPT	7501036		Washington Regional Medical Center	outpatient	730.12	365.06	Healthy Blue / Blue Cross NC	North Carolina Medicaid	256.71	192.57	547.59
LAC INTER SCLP/TK/EXT 2.6-7.5	LAC INTER SCLP/TK/EXT 2.6-7.5	Surgery	12032	CPT	7501036		Washington Regional Medical Center	outpatient	730.12	365.06	Cigna	North Carolina PPO-PPA Direct	192.57	192.57	547.59
LAC INTER SCLP/TK/EXT 2.6-7.5	LAC INTER SCLP/TK/EXT 2.6-7.5	Surgery	12032	CPT	7501036		Washington Regional Medical Center	outpatient	730.12	365.06	Original Medicare	Traditional Medicare Fee-for-Service	343.16	192.57	547.59
LAC SIMPLE FACE/EAR/LIP 2.6-5	LAC SIMPLE FACE/EAR/LIP 2.6-5	Surgery	12002	CPT	8001091		Washington Regional Medical Center	outpatient	709	354.5	Self-Pay	Discounted Cash		127.69	531.75
LAC SIMPLE FACE/EAR/LIP 2.6-5	LAC SIMPLE FACE/EAR/LIP 2.6-5	Surgery	12002	CPT	8001091		Washington Regional Medical Center	outpatient	709	354.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	531.75	127.69	531.75
LAC SIMPLE FACE/EAR/LIP 2.6-5	LAC SIMPLE FACE/EAR/LIP 2.6-5	Surgery	12002	CPT	8001091		Washington Regional Medical Center	outpatient	709	354.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	311.96	127.69	531.75
LAC SIMPLE FACE/EAR/LIP 2.6-5	LAC SIMPLE FACE/EAR/LIP 2.6-5	Surgery	12002	CPT	8001091		Washington Regional Medical Center	outpatient	709	354.5	Humana	Medicare Advantage HMO/PPO/PFFS	333.23	127.69	531.75
LAC SIMPLE FACE/EAR/LIP 2.6-5	LAC SIMPLE FACE/EAR/LIP 2.6-5	Surgery	12002	CPT	8001091		Washington Regional Medical Center	outpatient	709	354.5	AmeriHealth Caritas North Carolina	NC Medicaid	249.28	127.69	531.75
LAC SIMPLE FACE/EAR/LIP 2.6-5	LAC SIMPLE FACE/EAR/LIP 2.6-5	Surgery	12002	CPT	8001091		Washington Regional Medical Center	outpatient	709	354.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	249.28	127.69	531.75
LAC SIMPLE FACE/EAR/LIP 2.6-5	LAC SIMPLE FACE/EAR/LIP 2.6-5	Surgery	12002	CPT	8001091		Washington Regional Medical Center	outpatient	709	354.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	249.28	127.69	531.75
LAC SIMPLE FACE/EAR/LIP 2.6-5	LAC SIMPLE FACE/EAR/LIP 2.6-5	Surgery	12002	CPT	8001091		Washington Regional Medical Center	outpatient	709	354.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	249.28	127.69	531.75
LAC SIMPLE FACE/EAR/LIP 2.6-5	LAC SIMPLE FACE/EAR/LIP 2.6-5	Surgery	12002	CPT	8001091		Washington Regional Medical Center	outpatient	709	354.5	Cigna	North Carolina PPO-PPA Direct	127.69	127.69	531.75
LAC SIMPLE FACE/EAR/LIP 2.6-5	LAC SIMPLE FACE/EAR/LIP 2.6-5	Surgery	12002	CPT	8001091		Washington Regional Medical Center	outpatient	709	354.5	Original Medicare	Traditional Medicare Fee-for-Service	333.23	127.69	531.75
LAC SIMPLE FACE/EAR/LIP 5.1-7	LAC SIMPLE FACE/EAR/LIP 5.1-7	Surgery	12014	CPT	6000060		Washington Regional Medical Center	outpatient	459	229.5	Self-Pay	Discounted Cash		161.38	344.25
LAC SIMPLE FACE/EAR/LIP 5.1-7	LAC SIMPLE FACE/EAR/LIP 5.1-7	Surgery	12014	CPT	6000060		Washington Regional Medical Center	outpatient	459	229.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	344.25	161.38	344.25
LAC SIMPLE FACE/EAR/LIP 5.1-7	LAC SIMPLE FACE/EAR/LIP 5.1-7	Surgery	12014	CPT	6000060		Washington Regional Medical Center	outpatient	459	229.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	201.96	161.38	344.25
LAC SIMPLE FACE/EAR/LIP 5.1-7	LAC SIMPLE FACE/EAR/LIP 5.1-7	Surgery	12014	CPT	6000060		Washington Regional Medical Center	outpatient	459	229.5	Humana	Medicare Advantage HMO/PPO/PFFS	215.73	161.38	344.25
LAC SIMPLE FACE/EAR/LIP 5.1-7	LAC SIMPLE FACE/EAR/LIP 5.1-7	Surgery	12014	CPT	6000060		Washington Regional Medical Center	outpatient	459	229.5	AmeriHealth Caritas North Carolina	NC Medicaid	161.38	161.38	344.25
LAC SIMPLE FACE/EAR/LIP 5.1-7	LAC SIMPLE FACE/EAR/LIP 5.1-7	Surgery	12014	CPT	6000060		Washington Regional Medical Center	outpatient	459	229.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	161.38	161.38	344.25
LAC SIMPLE FACE/EAR/LIP 5.1-7	LAC SIMPLE FACE/EAR/LIP 5.1-7	Surgery	12014	CPT	6000060		Washington Regional Medical Center	outpatient	459	229.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	161.38	161.38	344.25
LAC SIMPLE FACE/EAR/LIP 5.1-7	LAC SIMPLE FACE/EAR/LIP 5.1-7	Surgery	12014	CPT	6000060		Washington Regional Medical Center	outpatient	459	229.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	161.38	161.38	344.25
LAC SIMPLE FACE/EAR/LIP 5.1-7	LAC SIMPLE FACE/EAR/LIP 5.1-7	Surgery	12014	CPT	6000060		Washington Regional Medical Center	outpatient	459	229.5	Cigna	North Carolina PPO-PPA Direct	163.16	161.38	344.25
LAC SIMPLE FACE/EAR/LIP 5.1-7	LAC SIMPLE FACE/EAR/LIP 5.1-7	Surgery	12014	CPT	6000060		Washington Regional Medical Center	outpatient	459	229.5	Original Medicare	Traditional Medicare Fee-for-Service	215.73	161.38	344.25
LAC SIMPLE FACE/EAR/LIP 5.1-7	LAC SIMPLE FACE/EAR/LIP 5.1-7	Surgery	12014	CPT	7501033		Washington Regional Medical Center	outpatient	459	229.5	Self-Pay	Discounted Cash		161.38	344.25
LAC SIMPLE FACE/EAR/LIP 5.1-7	LAC SIMPLE FACE/EAR/LIP 5.1-7	Surgery	12014	CPT	7501033		Washington Regional Medical Center	outpatient	459	229.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	344.25	161.38	344.25
LAC SIMPLE FACE/EAR/LIP 5.1-7	LAC SIMPLE FACE/EAR/LIP 5.1-7	Surgery	12014	CPT	7501033		Washington Regional Medical Center	outpatient	459	229.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	201.96	161.38	344.25
LAC SIMPLE FACE/EAR/LIP 5.1-7	LAC SIMPLE FACE/EAR/LIP 5.1-7	Surgery	12014	CPT	7501033		Washington Regional Medical Center	outpatient	459	229.5	Humana	Medicare Advantage HMO/PPO/PFFS	215.73	161.38	344.25
LAC SIMPLE FACE/EAR/LIP 5.1-7	LAC SIMPLE FACE/EAR/LIP 5.1-7	Surgery	12014	CPT	7501033		Washington Regional Medical Center	outpatient	459	229.5	AmeriHealth Caritas North Carolina	NC Medicaid	161.38	161.38	344.25
LAC SIMPLE FACE/EAR/LIP 5.1-7	LAC SIMPLE FACE/EAR/LIP 5.1-7	Surgery	12014	CPT	7501033		Washington Regional Medical Center	outpatient	459	229.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	161.38	161.38	344.25
LAC SIMPLE FACE/EAR/LIP 5.1-7	LAC SIMPLE FACE/EAR/LIP 5.1-7	Surgery	12014	CPT	7501033		Washington Regional Medical Center	outpatient	459	229.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	161.38	161.38	344.25
LAC SIMPLE FACE/EAR/LIP 5.1-7	LAC SIMPLE FACE/EAR/LIP 5.1-7	Surgery	12014	CPT	7501033		Washington Regional Medical Center	outpatient	459	229.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	161.38	161.38	344.25
LAC SIMPLE FACE/EAR/LIP 5.1-7	LAC SIMPLE FACE/EAR/LIP 5.1-7	Surgery	12014	CPT	7501033		Washington Regional Medical Center	outpatient	459	229.5	Cigna	North Carolina PPO-PPA Direct	163.16	161.38	344.25
LAC SIMPLE FACE/EAR/LIP 5.1-7	LAC SIMPLE FACE/EAR/LIP 5.1-7	Surgery	12014	CPT	7501033		Washington Regional Medical Center	outpatient	459	229.5	Original Medicare	Traditional Medicare Fee-for-Service	215.73	161.38	344.25
LAC SIMPLE SCALP/TRNK 2.6-7.5	LAC SIMPLE SCALP/TRNK 2.6-7.5	Surgery	12002	CPT	6000064		Washington Regional Medical Center	outpatient	493	246.5	Self-Pay	Discounted Cash		127.69	369.75
LAC SIMPLE SCALP/TRNK 2.6-7.5	LAC SIMPLE SCALP/TRNK 2.6-7.5	Surgery	12002	CPT	6000064		Washington Regional Medical Center	outpatient	493	246.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	369.75	127.69	369.75
LAC SIMPLE SCALP/TRNK 2.6-7.5	LAC SIMPLE SCALP/TRNK 2.6-7.5	Surgery	12002	CPT	6000064		Washington Regional Medical Center	outpatient	493	246.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	216.92	127.69	369.75
LAC SIMPLE SCALP/TRNK 2.6-7.5	LAC SIMPLE SCALP/TRNK 2.6-7.5	Surgery	12002	CPT	6000064		Washington Regional Medical Center	outpatient	493	246.5	Humana	Medicare Advantage HMO/PPO/PFFS	231.71	127.69	369.75
LAC SIMPLE SCALP/TRNK 2.6-7.5	LAC SIMPLE SCALP/TRNK 2.6-7.5	Surgery	12002	CPT	6000064		Washington Regional Medical Center	outpatient	493	246.5	AmeriHealth Caritas North Carolina	NC Medicaid	173.34	127.69	369.75
LAC SIMPLE SCALP/TRNK 2.6-7.5	LAC SIMPLE SCALP/TRNK 2.6-7.5	Surgery	12002	CPT	6000064		Washington Regional Medical Center	outpatient	493	246.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	173.34	127.69	369.75
LAC SIMPLE SCALP/TRNK 2.6-7.5	LAC SIMPLE SCALP/TRNK 2.6-7.5	Surgery	12002	CPT	6000064		Washington Regional Medical Center	outpatient	493	246.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	173.34	127.69	369.75
LAC SIMPLE SCALP/TRNK 2.6-7.5	LAC SIMPLE SCALP/TRNK 2.6-7.5	Surgery	12002	CPT	6000064		Washington Regional Medical Center	outpatient	493	246.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	173.34	127.69	369.75
LAC SIMPLE SCALP/TRNK 2.6-7.5	LAC SIMPLE SCALP/TRNK 2.6-7.5	Surgery	12002	CPT	6000064		Washington Regional Medical Center	outpatient	493	246.5	Cigna	North Carolina PPO-PPA Direct	127.69	127.69	369.75
LAC SIMPLE SCALP/TRNK 2.6-7.5	LAC SIMPLE SCALP/TRNK 2.6-7.5	Surgery	12002	CPT	6000064		Washington Regional Medical Center	outpatient	493	246.5	Original Medicare	Traditional Medicare Fee-for-Service	231.71	127.69	369.75
LAC SIMPLE SCALP/TRNK 2.6-7.5	LAC SIMPLE SCALP/TRNK 2.6-7.5	Surgery	12002	CPT	7501031		Washington Regional Medical Center	outpatient	493	246.5	Self-Pay	Discounted Cash		127.69	369.75
LAC SIMPLE SCALP/TRNK 2.6-7.5	LAC SIMPLE SCALP/TRNK 2.6-7.5	Surgery	12002	CPT	7501031		Washington Regional Medical Center	outpatient	493	246.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	369.75	127.69	369.75
LAC SIMPLE SCALP/TRNK 2.6-7.5	LAC SIMPLE SCALP/TRNK 2.6-7.5	Surgery	12002	CPT	7501031		Washington Regional Medical Center	outpatient	493	246.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	216.92	127.69	369.75
LAC SIMPLE SCALP/TRNK 2.6-7.5	LAC SIMPLE SCALP/TRNK 2.6-7.5	Surgery	12002	CPT	7501031		Washington Regional Medical Center	outpatient	493	246.5	Humana	Medicare Advantage HMO/PPO/PFFS	231.71	127.69	369.75
LAC SIMPLE SCALP/TRNK 2.6-7.5	LAC SIMPLE SCALP/TRNK 2.6-7.5	Surgery	12002	CPT	7501031		Washington Regional Medical Center	outpatient	493	246.5	AmeriHealth Caritas North Carolina	NC Medicaid	173.34	127.69	369.75
LAC SIMPLE SCALP/TRNK 2.6-7.5	LAC SIMPLE SCALP/TRNK 2.6-7.5	Surgery	12002	CPT	7501031		Washington Regional Medical Center	outpatient	493	246.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	173.34	127.69	369.75
LAC SIMPLE SCALP/TRNK 2.6-7.5	LAC SIMPLE SCALP/TRNK 2.6-7.5	Surgery	12002	CPT	7501031		Washington Regional Medical Center	outpatient	493	246.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	173.34	127.69	369.75
LAC SIMPLE SCALP/TRNK 2.6-7.5	LAC SIMPLE SCALP/TRNK 2.6-7.5	Surgery	12002	CPT	7501031		Washington Regional Medical Center	outpatient	493	246.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	173.34	127.69	369.75
LAC SIMPLE SCALP/TRNK 2.6-7.5	LAC SIMPLE SCALP/TRNK 2.6-7.5	Surgery	12002	CPT	7501031		Washington Regional Medical Center	outpatient	493	246.5	Cigna	North Carolina PPO-PPA Direct	127.69	127.69	369.75
LAC SIMPLE SCALP/TRNK 2.6-7.5	LAC SIMPLE SCALP/TRNK 2.6-7.5	Surgery	12002	CPT	7501031		Washington Regional Medical Center	outpatient	493	246.5	Original Medicare	Traditional Medicare Fee-for-Service	231.71	127.69	369.75
Laryngoscp Dir Op FB rem 31530	Laryngoscp Dir Op FB rem 31530	Surgery	31530	CPT	11056938		Washington Regional Medical Center	outpatient	150	75	Self-Pay	Discounted Cash		52.74	244.18
Laryngoscp Dir Op FB rem 31530	Laryngoscp Dir Op FB rem 31530	Surgery	31530	CPT	11056938		Washington Regional Medical Center	outpatient	150	75	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	112.5	52.74	244.18
Laryngoscp Dir Op FB rem 31530	Laryngoscp Dir Op FB rem 31530	Surgery	31530	CPT	11056938		Washington Regional Medical Center	outpatient	150	75	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	66	52.74	244.18
Laryngoscp Dir Op FB rem 31530	Laryngoscp Dir Op FB rem 31530	Surgery	31530	CPT	11056938		Washington Regional Medical Center	outpatient	150	75	Humana	Medicare Advantage HMO/PPO/PFFS	70.5	52.74	244.18
Laryngoscp Dir Op FB rem 31530	Laryngoscp Dir Op FB rem 31530	Surgery	31530	CPT	11056938		Washington Regional Medical Center	outpatient	150	75	AmeriHealth Caritas North Carolina	NC Medicaid	52.74	52.74	244.18
Laryngoscp Dir Op FB rem 31530	Laryngoscp Dir Op FB rem 31530	Surgery	31530	CPT	11056938		Washington Regional Medical Center	outpatient	150	75	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	52.74	52.74	244.18
Laryngoscp Dir Op FB rem 31530	Laryngoscp Dir Op FB rem 31530	Surgery	31530	CPT	11056938		Washington Regional Medical Center	outpatient	150	75	WellCare of North Carolina	North Carolina Medicaid/CHIP	52.74	52.74	244.18
Laryngoscp Dir Op FB rem 31530	Laryngoscp Dir Op FB rem 31530	Surgery	31530	CPT	11056938		Washington Regional Medical Center	outpatient	150	75	Healthy Blue / Blue Cross NC	North Carolina Medicaid	52.74	52.74	244.18
Laryngoscp Dir Op FB rem 31530	Laryngoscp Dir Op FB rem 31530	Surgery	31530	CPT	11056938		Washington Regional Medical Center	outpatient	150	75	Cigna	North Carolina PPO-PPA Direct	244.18	52.74	244.18
Laryngoscp Dir Op FB rem 31530	Laryngoscp Dir Op FB rem 31530	Surgery	31530	CPT	11056938		Washington Regional Medical Center	outpatient	150	75	Original Medicare	Traditional Medicare Fee-for-Service	70.5	52.74	244.18
Neuroplast/Trnsp UlnNrvW 64719	Neuroplast/Trnsp UlnNrvW 64719	Surgery	64719	CPT	6120599		Washington Regional Medical Center	outpatient	1592.24	796.12	Self-Pay	Discounted Cash		432.66	1194.18
Neuroplast/Trnsp UlnNrvW 64719	Neuroplast/Trnsp UlnNrvW 64719	Surgery	64719	CPT	6120599		Washington Regional Medical Center	outpatient	1592.24	796.12	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1194.18	432.66	1194.18
Neuroplast/Trnsp UlnNrvW 64719	Neuroplast/Trnsp UlnNrvW 64719	Surgery	64719	CPT	6120599		Washington Regional Medical Center	outpatient	1592.24	796.12	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	700.59	432.66	1194.18
Neuroplast/Trnsp UlnNrvW 64719	Neuroplast/Trnsp UlnNrvW 64719	Surgery	64719	CPT	6120599		Washington Regional Medical Center	outpatient	1592.24	796.12	Humana	Medicare Advantage HMO/PPO/PFFS	748.35	432.66	1194.18
Neuroplast/Trnsp UlnNrvW 64719	Neuroplast/Trnsp UlnNrvW 64719	Surgery	64719	CPT	6120599		Washington Regional Medical Center	outpatient	1592.24	796.12	AmeriHealth Caritas North Carolina	NC Medicaid	559.83	432.66	1194.18
Neuroplast/Trnsp UlnNrvW 64719	Neuroplast/Trnsp UlnNrvW 64719	Surgery	64719	CPT	6120599		Washington Regional Medical Center	outpatient	1592.24	796.12	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	559.83	432.66	1194.18
Neuroplast/Trnsp UlnNrvW 64719	Neuroplast/Trnsp UlnNrvW 64719	Surgery	64719	CPT	6120599		Washington Regional Medical Center	outpatient	1592.24	796.12	WellCare of North Carolina	North Carolina Medicaid/CHIP	559.83	432.66	1194.18
Neuroplast/Trnsp UlnNrvW 64719	Neuroplast/Trnsp UlnNrvW 64719	Surgery	64719	CPT	6120599		Washington Regional Medical Center	outpatient	1592.24	796.12	Healthy Blue / Blue Cross NC	North Carolina Medicaid	559.83	432.66	1194.18
Neuroplast/Trnsp UlnNrvW 64719	Neuroplast/Trnsp UlnNrvW 64719	Surgery	64719	CPT	6120599		Washington Regional Medical Center	outpatient	1592.24	796.12	Cigna	North Carolina PPO-PPA Direct	432.66	432.66	1194.18
Neuroplast/Trnsp UlnNrvW 64719	Neuroplast/Trnsp UlnNrvW 64719	Surgery	64719	CPT	6120599		Washington Regional Medical Center	outpatient	1592.24	796.12	Original Medicare	Traditional Medicare Fee-for-Service	748.35	432.66	1194.18
NON-TUNNEL CENTRAL CATH 5>	NON-TUNNEL CENTRAL CATH 5>	Surgery	36556	CPT	6001108		Washington Regional Medical Center	outpatient	111	55.5	Self-Pay	Discounted Cash		39.03	150.35
NON-TUNNEL CENTRAL CATH 5>	NON-TUNNEL CENTRAL CATH 5>	Surgery	36556	CPT	6001108		Washington Regional Medical Center	outpatient	111	55.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	83.25	39.03	150.35
NON-TUNNEL CENTRAL CATH 5>	NON-TUNNEL CENTRAL CATH 5>	Surgery	36556	CPT	6001108		Washington Regional Medical Center	outpatient	111	55.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	48.84	39.03	150.35
NON-TUNNEL CENTRAL CATH 5>	NON-TUNNEL CENTRAL CATH 5>	Surgery	36556	CPT	6001108		Washington Regional Medical Center	outpatient	111	55.5	Humana	Medicare Advantage HMO/PPO/PFFS	52.17	39.03	150.35
NON-TUNNEL CENTRAL CATH 5>	NON-TUNNEL CENTRAL CATH 5>	Surgery	36556	CPT	6001108		Washington Regional Medical Center	outpatient	111	55.5	AmeriHealth Caritas North Carolina	NC Medicaid	39.03	39.03	150.35
NON-TUNNEL CENTRAL CATH 5>	NON-TUNNEL CENTRAL CATH 5>	Surgery	36556	CPT	6001108		Washington Regional Medical Center	outpatient	111	55.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	39.03	39.03	150.35
NON-TUNNEL CENTRAL CATH 5>	NON-TUNNEL CENTRAL CATH 5>	Surgery	36556	CPT	6001108		Washington Regional Medical Center	outpatient	111	55.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	39.03	39.03	150.35
NON-TUNNEL CENTRAL CATH 5>	NON-TUNNEL CENTRAL CATH 5>	Surgery	36556	CPT	6001108		Washington Regional Medical Center	outpatient	111	55.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	39.03	39.03	150.35
NON-TUNNEL CENTRAL CATH 5>	NON-TUNNEL CENTRAL CATH 5>	Surgery	36556	CPT	6001108		Washington Regional Medical Center	outpatient	111	55.5	Cigna	North Carolina PPO-PPA Direct	150.35	39.03	150.35
NON-TUNNEL CENTRAL CATH 5>	NON-TUNNEL CENTRAL CATH 5>	Surgery	36556	CPT	6001108		Washington Regional Medical Center	outpatient	111	55.5	Original Medicare	Traditional Medicare Fee-for-Service	52.17	39.03	150.35
RADIAL/ULNAR FX W/O MANIP	RADIAL/ULNAR FX W/O MANIP	Surgery	25560	CPT	6001201		Washington Regional Medical Center	outpatient	1014	507	Self-Pay	Discounted Cash		229.94	760.5
RADIAL/ULNAR FX W/O MANIP	RADIAL/ULNAR FX W/O MANIP	Surgery	25560	CPT	6001201		Washington Regional Medical Center	outpatient	1014	507	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	760.5	229.94	760.5
RADIAL/ULNAR FX W/O MANIP	RADIAL/ULNAR FX W/O MANIP	Surgery	25560	CPT	6001201		Washington Regional Medical Center	outpatient	1014	507	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	446.16	229.94	760.5
RADIAL/ULNAR FX W/O MANIP	RADIAL/ULNAR FX W/O MANIP	Surgery	25560	CPT	6001201		Washington Regional Medical Center	outpatient	1014	507	Humana	Medicare Advantage HMO/PPO/PFFS	476.58	229.94	760.5
RADIAL/ULNAR FX W/O MANIP	RADIAL/ULNAR FX W/O MANIP	Surgery	25560	CPT	6001201		Washington Regional Medical Center	outpatient	1014	507	AmeriHealth Caritas North Carolina	NC Medicaid	356.52	229.94	760.5
RADIAL/ULNAR FX W/O MANIP	RADIAL/ULNAR FX W/O MANIP	Surgery	25560	CPT	6001201		Washington Regional Medical Center	outpatient	1014	507	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	356.52	229.94	760.5
RADIAL/ULNAR FX W/O MANIP	RADIAL/ULNAR FX W/O MANIP	Surgery	25560	CPT	6001201		Washington Regional Medical Center	outpatient	1014	507	WellCare of North Carolina	North Carolina Medicaid/CHIP	356.52	229.94	760.5
RADIAL/ULNAR FX W/O MANIP	RADIAL/ULNAR FX W/O MANIP	Surgery	25560	CPT	6001201		Washington Regional Medical Center	outpatient	1014	507	Healthy Blue / Blue Cross NC	North Carolina Medicaid	356.52	229.94	760.5
RADIAL/ULNAR FX W/O MANIP	RADIAL/ULNAR FX W/O MANIP	Surgery	25560	CPT	6001201		Washington Regional Medical Center	outpatient	1014	507	Cigna	North Carolina PPO-PPA Direct	229.94	229.94	760.5
RADIAL/ULNAR FX W/O MANIP	RADIAL/ULNAR FX W/O MANIP	Surgery	25560	CPT	6001201		Washington Regional Medical Center	outpatient	1014	507	Original Medicare	Traditional Medicare Fee-for-Service	476.58	229.94	760.5
Rem FB Intrnsl Req G Ans 30310	Rem FB Intrnsl Req G Ans 30310	Surgery	30310	CPT	8078276		Washington Regional Medical Center	outpatient	227	113.5	Self-Pay	Discounted Cash		79.81	224.49
Rem FB Intrnsl Req G Ans 30310	Rem FB Intrnsl Req G Ans 30310	Surgery	30310	CPT	8078276		Washington Regional Medical Center	outpatient	227	113.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	170.25	79.81	224.49
Rem FB Intrnsl Req G Ans 30310	Rem FB Intrnsl Req G Ans 30310	Surgery	30310	CPT	8078276		Washington Regional Medical Center	outpatient	227	113.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	99.88	79.81	224.49
Rem FB Intrnsl Req G Ans 30310	Rem FB Intrnsl Req G Ans 30310	Surgery	30310	CPT	8078276		Washington Regional Medical Center	outpatient	227	113.5	Humana	Medicare Advantage HMO/PPO/PFFS	106.69	79.81	224.49
Rem FB Intrnsl Req G Ans 30310	Rem FB Intrnsl Req G Ans 30310	Surgery	30310	CPT	8078276		Washington Regional Medical Center	outpatient	227	113.5	AmeriHealth Caritas North Carolina	NC Medicaid	79.81	79.81	224.49
Rem FB Intrnsl Req G Ans 30310	Rem FB Intrnsl Req G Ans 30310	Surgery	30310	CPT	8078276		Washington Regional Medical Center	outpatient	227	113.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	79.81	79.81	224.49
Rem FB Intrnsl Req G Ans 30310	Rem FB Intrnsl Req G Ans 30310	Surgery	30310	CPT	8078276		Washington Regional Medical Center	outpatient	227	113.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	79.81	79.81	224.49
Rem FB Intrnsl Req G Ans 30310	Rem FB Intrnsl Req G Ans 30310	Surgery	30310	CPT	8078276		Washington Regional Medical Center	outpatient	227	113.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	79.81	79.81	224.49
Rem FB Intrnsl Req G Ans 30310	Rem FB Intrnsl Req G Ans 30310	Surgery	30310	CPT	8078276		Washington Regional Medical Center	outpatient	227	113.5	Cigna	North Carolina PPO-PPA Direct	224.49	79.81	224.49
Rem FB Intrnsl Req G Ans 30310	Rem FB Intrnsl Req G Ans 30310	Surgery	30310	CPT	8078276		Washington Regional Medical Center	outpatient	227	113.5	Original Medicare	Traditional Medicare Fee-for-Service	106.69	79.81	224.49
REM IMPACT CERUMEN	REM IMPACT CERUMEN	Surgery	69210	CPT	7501153		Washington Regional Medical Center	outpatient	43	21.5	Self-Pay	Discounted Cash		15.12	38.87
REM IMPACT CERUMEN	REM IMPACT CERUMEN	Surgery	69210	CPT	7501153		Washington Regional Medical Center	outpatient	43	21.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	32.25	15.12	38.87
REM IMPACT CERUMEN	REM IMPACT CERUMEN	Surgery	69210	CPT	7501153		Washington Regional Medical Center	outpatient	43	21.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	18.92	15.12	38.87
REM IMPACT CERUMEN	REM IMPACT CERUMEN	Surgery	69210	CPT	7501153		Washington Regional Medical Center	outpatient	43	21.5	Humana	Medicare Advantage HMO/PPO/PFFS	20.21	15.12	38.87
REM IMPACT CERUMEN	REM IMPACT CERUMEN	Surgery	69210	CPT	7501153		Washington Regional Medical Center	outpatient	43	21.5	AmeriHealth Caritas North Carolina	NC Medicaid	15.12	15.12	38.87
REM IMPACT CERUMEN	REM IMPACT CERUMEN	Surgery	69210	CPT	7501153		Washington Regional Medical Center	outpatient	43	21.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	15.12	15.12	38.87
REM IMPACT CERUMEN	REM IMPACT CERUMEN	Surgery	69210	CPT	7501153		Washington Regional Medical Center	outpatient	43	21.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	15.12	15.12	38.87
REM IMPACT CERUMEN	REM IMPACT CERUMEN	Surgery	69210	CPT	7501153		Washington Regional Medical Center	outpatient	43	21.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	15.12	15.12	38.87
REM IMPACT CERUMEN	REM IMPACT CERUMEN	Surgery	69210	CPT	7501153		Washington Regional Medical Center	outpatient	43	21.5	Cigna	North Carolina PPO-PPA Direct	38.87	15.12	38.87
REM IMPACT CERUMEN	REM IMPACT CERUMEN	Surgery	69210	CPT	7501153		Washington Regional Medical Center	outpatient	43	21.5	Original Medicare	Traditional Medicare Fee-for-Service	20.21	15.12	38.87
REM IMPACT CERUMEN W/INST UNI	REM IMPACT CERUMEN W/INST UNI	Surgery	69210	CPT	6000045		Washington Regional Medical Center	outpatient	43	21.5	Self-Pay	Discounted Cash		15.12	38.87
REM IMPACT CERUMEN W/INST UNI	REM IMPACT CERUMEN W/INST UNI	Surgery	69210	CPT	6000045		Washington Regional Medical Center	outpatient	43	21.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	32.25	15.12	38.87
REM IMPACT CERUMEN W/INST UNI	REM IMPACT CERUMEN W/INST UNI	Surgery	69210	CPT	6000045		Washington Regional Medical Center	outpatient	43	21.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	18.92	15.12	38.87
REM IMPACT CERUMEN W/INST UNI	REM IMPACT CERUMEN W/INST UNI	Surgery	69210	CPT	6000045		Washington Regional Medical Center	outpatient	43	21.5	Humana	Medicare Advantage HMO/PPO/PFFS	20.21	15.12	38.87
REM IMPACT CERUMEN W/INST UNI	REM IMPACT CERUMEN W/INST UNI	Surgery	69210	CPT	6000045		Washington Regional Medical Center	outpatient	43	21.5	AmeriHealth Caritas North Carolina	NC Medicaid	15.12	15.12	38.87
REM IMPACT CERUMEN W/INST UNI	REM IMPACT CERUMEN W/INST UNI	Surgery	69210	CPT	6000045		Washington Regional Medical Center	outpatient	43	21.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	15.12	15.12	38.87
REM IMPACT CERUMEN W/INST UNI	REM IMPACT CERUMEN W/INST UNI	Surgery	69210	CPT	6000045		Washington Regional Medical Center	outpatient	43	21.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	15.12	15.12	38.87
REM IMPACT CERUMEN W/INST UNI	REM IMPACT CERUMEN W/INST UNI	Surgery	69210	CPT	6000045		Washington Regional Medical Center	outpatient	43	21.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	15.12	15.12	38.87
REM IMPACT CERUMEN W/INST UNI	REM IMPACT CERUMEN W/INST UNI	Surgery	69210	CPT	6000045		Washington Regional Medical Center	outpatient	43	21.5	Cigna	North Carolina PPO-PPA Direct	38.87	15.12	38.87
REM IMPACT CERUMEN W/INST UNI	REM IMPACT CERUMEN W/INST UNI	Surgery	69210	CPT	6000045		Washington Regional Medical Center	outpatient	43	21.5	Original Medicare	Traditional Medicare Fee-for-Service	20.21	15.12	38.87
Remove FB Foot 28192	Remove FB Foot 28192	Surgery	28192	CPT	5206495		Washington Regional Medical Center	outpatient	1789.32	894.66	Self-Pay	Discounted Cash		380.85	1341.99
Remove FB Foot 28192	Remove FB Foot 28192	Surgery	28192	CPT	5206495		Washington Regional Medical Center	outpatient	1789.32	894.66	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1341.99	380.85	1341.99
Remove FB Foot 28192	Remove FB Foot 28192	Surgery	28192	CPT	5206495		Washington Regional Medical Center	outpatient	1789.32	894.66	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	787.3	380.85	1341.99
Remove FB Foot 28192	Remove FB Foot 28192	Surgery	28192	CPT	5206495		Washington Regional Medical Center	outpatient	1789.32	894.66	Humana	Medicare Advantage HMO/PPO/PFFS	840.98	380.85	1341.99
Remove FB Foot 28192	Remove FB Foot 28192	Surgery	28192	CPT	5206495		Washington Regional Medical Center	outpatient	1789.32	894.66	AmeriHealth Caritas North Carolina	NC Medicaid	629.12	380.85	1341.99
Remove FB Foot 28192	Remove FB Foot 28192	Surgery	28192	CPT	5206495		Washington Regional Medical Center	outpatient	1789.32	894.66	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	629.12	380.85	1341.99
Remove FB Foot 28192	Remove FB Foot 28192	Surgery	28192	CPT	5206495		Washington Regional Medical Center	outpatient	1789.32	894.66	WellCare of North Carolina	North Carolina Medicaid/CHIP	629.12	380.85	1341.99
Remove FB Foot 28192	Remove FB Foot 28192	Surgery	28192	CPT	5206495		Washington Regional Medical Center	outpatient	1789.32	894.66	Healthy Blue / Blue Cross NC	North Carolina Medicaid	629.12	380.85	1341.99
Remove FB Foot 28192	Remove FB Foot 28192	Surgery	28192	CPT	5206495		Washington Regional Medical Center	outpatient	1789.32	894.66	Cigna	North Carolina PPO-PPA Direct	380.85	380.85	1341.99
Remove FB Foot 28192	Remove FB Foot 28192	Surgery	28192	CPT	5206495		Washington Regional Medical Center	outpatient	1789.32	894.66	Original Medicare	Traditional Medicare Fee-for-Service	840.98	380.85	1341.99
Remove Indw-Tunn PleCath 32552	Remove Indw-Tunn PleCath 32552	Surgery	32552	CPT	10806922		Washington Regional Medical Center	outpatient	613.4	306.7	Self-Pay	Discounted Cash		189.96	460.05
Remove Indw-Tunn PleCath 32552	Remove Indw-Tunn PleCath 32552	Surgery	32552	CPT	10806922		Washington Regional Medical Center	outpatient	613.4	306.7	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	460.05	189.96	460.05
Remove Indw-Tunn PleCath 32552	Remove Indw-Tunn PleCath 32552	Surgery	32552	CPT	10806922		Washington Regional Medical Center	outpatient	613.4	306.7	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	269.9	189.96	460.05
Remove Indw-Tunn PleCath 32552	Remove Indw-Tunn PleCath 32552	Surgery	32552	CPT	10806922		Washington Regional Medical Center	outpatient	613.4	306.7	Humana	Medicare Advantage HMO/PPO/PFFS	288.3	189.96	460.05
Remove Indw-Tunn PleCath 32552	Remove Indw-Tunn PleCath 32552	Surgery	32552	CPT	10806922		Washington Regional Medical Center	outpatient	613.4	306.7	AmeriHealth Caritas North Carolina	NC Medicaid	215.67	189.96	460.05
Remove Indw-Tunn PleCath 32552	Remove Indw-Tunn PleCath 32552	Surgery	32552	CPT	10806922		Washington Regional Medical Center	outpatient	613.4	306.7	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	215.67	189.96	460.05
Remove Indw-Tunn PleCath 32552	Remove Indw-Tunn PleCath 32552	Surgery	32552	CPT	10806922		Washington Regional Medical Center	outpatient	613.4	306.7	WellCare of North Carolina	North Carolina Medicaid/CHIP	215.67	189.96	460.05
Remove Indw-Tunn PleCath 32552	Remove Indw-Tunn PleCath 32552	Surgery	32552	CPT	10806922		Washington Regional Medical Center	outpatient	613.4	306.7	Healthy Blue / Blue Cross NC	North Carolina Medicaid	215.67	189.96	460.05
Remove Indw-Tunn PleCath 32552	Remove Indw-Tunn PleCath 32552	Surgery	32552	CPT	10806922		Washington Regional Medical Center	outpatient	613.4	306.7	Cigna	North Carolina PPO-PPA Direct	189.96	189.96	460.05
Remove Indw-Tunn PleCath 32552	Remove Indw-Tunn PleCath 32552	Surgery	32552	CPT	10806922		Washington Regional Medical Center	outpatient	613.4	306.7	Original Medicare	Traditional Medicare Fee-for-Service	288.3	189.96	460.05
Repair Lip Fll Thck Verm 40650	Repair Lip Fll Thck Verm 40650	Surgery	40650	CPT	10239200		Washington Regional Medical Center	outpatient	1214.88	607.44	Self-Pay	Discounted Cash		314.54	911.16
Repair Lip Fll Thck Verm 40650	Repair Lip Fll Thck Verm 40650	Surgery	40650	CPT	10239200		Washington Regional Medical Center	outpatient	1214.88	607.44	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	911.16	314.54	911.16
Repair Lip Fll Thck Verm 40650	Repair Lip Fll Thck Verm 40650	Surgery	40650	CPT	10239200		Washington Regional Medical Center	outpatient	1214.88	607.44	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	534.55	314.54	911.16
Repair Lip Fll Thck Verm 40650	Repair Lip Fll Thck Verm 40650	Surgery	40650	CPT	10239200		Washington Regional Medical Center	outpatient	1214.88	607.44	Humana	Medicare Advantage HMO/PPO/PFFS	570.99	314.54	911.16
Repair Lip Fll Thck Verm 40650	Repair Lip Fll Thck Verm 40650	Surgery	40650	CPT	10239200		Washington Regional Medical Center	outpatient	1214.88	607.44	AmeriHealth Caritas North Carolina	NC Medicaid	427.15	314.54	911.16
Repair Lip Fll Thck Verm 40650	Repair Lip Fll Thck Verm 40650	Surgery	40650	CPT	10239200		Washington Regional Medical Center	outpatient	1214.88	607.44	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	427.15	314.54	911.16
Repair Lip Fll Thck Verm 40650	Repair Lip Fll Thck Verm 40650	Surgery	40650	CPT	10239200		Washington Regional Medical Center	outpatient	1214.88	607.44	WellCare of North Carolina	North Carolina Medicaid/CHIP	427.15	314.54	911.16
Repair Lip Fll Thck Verm 40650	Repair Lip Fll Thck Verm 40650	Surgery	40650	CPT	10239200		Washington Regional Medical Center	outpatient	1214.88	607.44	Healthy Blue / Blue Cross NC	North Carolina Medicaid	427.15	314.54	911.16
Repair Lip Fll Thck Verm 40650	Repair Lip Fll Thck Verm 40650	Surgery	40650	CPT	10239200		Washington Regional Medical Center	outpatient	1214.88	607.44	Cigna	North Carolina PPO-PPA Direct	314.54	314.54	911.16
Repair Lip Fll Thck Verm 40650	Repair Lip Fll Thck Verm 40650	Surgery	40650	CPT	10239200		Washington Regional Medical Center	outpatient	1214.88	607.44	Original Medicare	Traditional Medicare Fee-for-Service	570.99	314.54	911.16
Repair wounds face 20.1 cm to 30.0 cm	Repair wounds face 20.1 cm to 30.0 cm	Surgery	12056	CPT	7501413		Washington Regional Medical Center	outpatient	2080	1040	Self-Pay	Discounted Cash		382.74	1560
Repair wounds face 20.1 cm to 30.0 cm	Repair wounds face 20.1 cm to 30.0 cm	Surgery	12056	CPT	7501413		Washington Regional Medical Center	outpatient	2080	1040	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1560	382.74	1560
Repair wounds face 20.1 cm to 30.0 cm	Repair wounds face 20.1 cm to 30.0 cm	Surgery	12056	CPT	7501413		Washington Regional Medical Center	outpatient	2080	1040	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	915.2	382.74	1560
Repair wounds face 20.1 cm to 30.0 cm	Repair wounds face 20.1 cm to 30.0 cm	Surgery	12056	CPT	7501413		Washington Regional Medical Center	outpatient	2080	1040	Humana	Medicare Advantage HMO/PPO/PFFS	977.6	382.74	1560
Repair wounds face 20.1 cm to 30.0 cm	Repair wounds face 20.1 cm to 30.0 cm	Surgery	12056	CPT	7501413		Washington Regional Medical Center	outpatient	2080	1040	AmeriHealth Caritas North Carolina	NC Medicaid	731.33	382.74	1560
Repair wounds face 20.1 cm to 30.0 cm	Repair wounds face 20.1 cm to 30.0 cm	Surgery	12056	CPT	7501413		Washington Regional Medical Center	outpatient	2080	1040	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	731.33	382.74	1560
Repair wounds face 20.1 cm to 30.0 cm	Repair wounds face 20.1 cm to 30.0 cm	Surgery	12056	CPT	7501413		Washington Regional Medical Center	outpatient	2080	1040	WellCare of North Carolina	North Carolina Medicaid/CHIP	731.33	382.74	1560
Repair wounds face 20.1 cm to 30.0 cm	Repair wounds face 20.1 cm to 30.0 cm	Surgery	12056	CPT	7501413		Washington Regional Medical Center	outpatient	2080	1040	Healthy Blue / Blue Cross NC	North Carolina Medicaid	731.33	382.74	1560
Repair wounds face 20.1 cm to 30.0 cm	Repair wounds face 20.1 cm to 30.0 cm	Surgery	12056	CPT	7501413		Washington Regional Medical Center	outpatient	2080	1040	Cigna	North Carolina PPO-PPA Direct	382.74	382.74	1560
Repair wounds face 20.1 cm to 30.0 cm	Repair wounds face 20.1 cm to 30.0 cm	Surgery	12056	CPT	7501413		Washington Regional Medical Center	outpatient	2080	1040	Original Medicare	Traditional Medicare Fee-for-Service	977.6	382.74	1560
Repair wounds face 20.1 cm to 30.0 cm	Repair wounds face 20.1 cm to 30.0 cm	Surgery	12056	CPT	7501423		Washington Regional Medical Center	outpatient	2080	1040	Self-Pay	Discounted Cash		382.74	1560
Repair wounds face 20.1 cm to 30.0 cm	Repair wounds face 20.1 cm to 30.0 cm	Surgery	12056	CPT	7501423		Washington Regional Medical Center	outpatient	2080	1040	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1560	382.74	1560
Repair wounds face 20.1 cm to 30.0 cm	Repair wounds face 20.1 cm to 30.0 cm	Surgery	12056	CPT	7501423		Washington Regional Medical Center	outpatient	2080	1040	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	915.2	382.74	1560
Repair wounds face 20.1 cm to 30.0 cm	Repair wounds face 20.1 cm to 30.0 cm	Surgery	12056	CPT	7501423		Washington Regional Medical Center	outpatient	2080	1040	Humana	Medicare Advantage HMO/PPO/PFFS	977.6	382.74	1560
Repair wounds face 20.1 cm to 30.0 cm	Repair wounds face 20.1 cm to 30.0 cm	Surgery	12056	CPT	7501423		Washington Regional Medical Center	outpatient	2080	1040	AmeriHealth Caritas North Carolina	NC Medicaid	731.33	382.74	1560
Repair wounds face 20.1 cm to 30.0 cm	Repair wounds face 20.1 cm to 30.0 cm	Surgery	12056	CPT	7501423		Washington Regional Medical Center	outpatient	2080	1040	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	731.33	382.74	1560
Repair wounds face 20.1 cm to 30.0 cm	Repair wounds face 20.1 cm to 30.0 cm	Surgery	12056	CPT	7501423		Washington Regional Medical Center	outpatient	2080	1040	WellCare of North Carolina	North Carolina Medicaid/CHIP	731.33	382.74	1560
Repair wounds face 20.1 cm to 30.0 cm	Repair wounds face 20.1 cm to 30.0 cm	Surgery	12056	CPT	7501423		Washington Regional Medical Center	outpatient	2080	1040	Healthy Blue / Blue Cross NC	North Carolina Medicaid	731.33	382.74	1560
Repair wounds face 20.1 cm to 30.0 cm	Repair wounds face 20.1 cm to 30.0 cm	Surgery	12056	CPT	7501423		Washington Regional Medical Center	outpatient	2080	1040	Cigna	North Carolina PPO-PPA Direct	382.74	382.74	1560
Repair wounds face 20.1 cm to 30.0 cm	Repair wounds face 20.1 cm to 30.0 cm	Surgery	12056	CPT	7501423		Washington Regional Medical Center	outpatient	2080	1040	Original Medicare	Traditional Medicare Fee-for-Service	977.6	382.74	1560
Scop Knee OstchndrlAlgrft29867	Scop Knee OstchndrlAlgrft29867	Surgery	29867	CPT	5206533		Washington Regional Medical Center	outpatient	140	70	Self-Pay	Discounted Cash		49.22	1409.56
Scop Knee OstchndrlAlgrft29867	Scop Knee OstchndrlAlgrft29867	Surgery	29867	CPT	5206533		Washington Regional Medical Center	outpatient	140	70	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	105	49.22	1409.56
Scop Knee OstchndrlAlgrft29867	Scop Knee OstchndrlAlgrft29867	Surgery	29867	CPT	5206533		Washington Regional Medical Center	outpatient	140	70	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	61.6	49.22	1409.56
Scop Knee OstchndrlAlgrft29867	Scop Knee OstchndrlAlgrft29867	Surgery	29867	CPT	5206533		Washington Regional Medical Center	outpatient	140	70	Humana	Medicare Advantage HMO/PPO/PFFS	65.8	49.22	1409.56
Scop Knee OstchndrlAlgrft29867	Scop Knee OstchndrlAlgrft29867	Surgery	29867	CPT	5206533		Washington Regional Medical Center	outpatient	140	70	AmeriHealth Caritas North Carolina	NC Medicaid	49.22	49.22	1409.56
Scop Knee OstchndrlAlgrft29867	Scop Knee OstchndrlAlgrft29867	Surgery	29867	CPT	5206533		Washington Regional Medical Center	outpatient	140	70	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	49.22	49.22	1409.56
Scop Knee OstchndrlAlgrft29867	Scop Knee OstchndrlAlgrft29867	Surgery	29867	CPT	5206533		Washington Regional Medical Center	outpatient	140	70	WellCare of North Carolina	North Carolina Medicaid/CHIP	49.22	49.22	1409.56
Scop Knee OstchndrlAlgrft29867	Scop Knee OstchndrlAlgrft29867	Surgery	29867	CPT	5206533		Washington Regional Medical Center	outpatient	140	70	Healthy Blue / Blue Cross NC	North Carolina Medicaid	49.22	49.22	1409.56
Scop Knee OstchndrlAlgrft29867	Scop Knee OstchndrlAlgrft29867	Surgery	29867	CPT	5206533		Washington Regional Medical Center	outpatient	140	70	Cigna	North Carolina PPO-PPA Direct	1409.56	49.22	1409.56
Scop Knee OstchndrlAlgrft29867	Scop Knee OstchndrlAlgrft29867	Surgery	29867	CPT	5206533		Washington Regional Medical Center	outpatient	140	70	Original Medicare	Traditional Medicare Fee-for-Service	65.8	49.22	1409.56
Shoulder Arthroscopy Dx 29805	Shoulder Arthroscopy Dx 29805	Surgery	29805	CPT	5206522		Washington Regional Medical Center	outpatient	60	30	Self-Pay	Discounted Cash		21.1	535.03
Shoulder Arthroscopy Dx 29805	Shoulder Arthroscopy Dx 29805	Surgery	29805	CPT	5206522		Washington Regional Medical Center	outpatient	60	30	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	45	21.1	535.03
Shoulder Arthroscopy Dx 29805	Shoulder Arthroscopy Dx 29805	Surgery	29805	CPT	5206522		Washington Regional Medical Center	outpatient	60	30	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	26.4	21.1	535.03
Shoulder Arthroscopy Dx 29805	Shoulder Arthroscopy Dx 29805	Surgery	29805	CPT	5206522		Washington Regional Medical Center	outpatient	60	30	Humana	Medicare Advantage HMO/PPO/PFFS	28.2	21.1	535.03
Shoulder Arthroscopy Dx 29805	Shoulder Arthroscopy Dx 29805	Surgery	29805	CPT	5206522		Washington Regional Medical Center	outpatient	60	30	AmeriHealth Caritas North Carolina	NC Medicaid	21.1	21.1	535.03
Shoulder Arthroscopy Dx 29805	Shoulder Arthroscopy Dx 29805	Surgery	29805	CPT	5206522		Washington Regional Medical Center	outpatient	60	30	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	21.1	21.1	535.03
Shoulder Arthroscopy Dx 29805	Shoulder Arthroscopy Dx 29805	Surgery	29805	CPT	5206522		Washington Regional Medical Center	outpatient	60	30	WellCare of North Carolina	North Carolina Medicaid/CHIP	21.1	21.1	535.03
Shoulder Arthroscopy Dx 29805	Shoulder Arthroscopy Dx 29805	Surgery	29805	CPT	5206522		Washington Regional Medical Center	outpatient	60	30	Healthy Blue / Blue Cross NC	North Carolina Medicaid	21.1	21.1	535.03
Shoulder Arthroscopy Dx 29805	Shoulder Arthroscopy Dx 29805	Surgery	29805	CPT	5206522		Washington Regional Medical Center	outpatient	60	30	Cigna	North Carolina PPO-PPA Direct	535.03	21.1	535.03
Shoulder Arthroscopy Dx 29805	Shoulder Arthroscopy Dx 29805	Surgery	29805	CPT	5206522		Washington Regional Medical Center	outpatient	60	30	Original Medicare	Traditional Medicare Fee-for-Service	28.2	21.1	535.03
Shv Lesn S/n/h/ft/g >2cm 11308	Shv Lesn S/n/h/ft/g >2cm 11308	Surgery	11308	CPT	7817468		Washington Regional Medical Center	outpatient	106	53	Self-Pay	Discounted Cash		37.27	92.73
Shv Lesn S/n/h/ft/g >2cm 11308	Shv Lesn S/n/h/ft/g >2cm 11308	Surgery	11308	CPT	7817468		Washington Regional Medical Center	outpatient	106	53	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	79.5	37.27	92.73
Shv Lesn S/n/h/ft/g >2cm 11308	Shv Lesn S/n/h/ft/g >2cm 11308	Surgery	11308	CPT	7817468		Washington Regional Medical Center	outpatient	106	53	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	46.64	37.27	92.73
Shv Lesn S/n/h/ft/g >2cm 11308	Shv Lesn S/n/h/ft/g >2cm 11308	Surgery	11308	CPT	7817468		Washington Regional Medical Center	outpatient	106	53	Humana	Medicare Advantage HMO/PPO/PFFS	49.82	37.27	92.73
Shv Lesn S/n/h/ft/g >2cm 11308	Shv Lesn S/n/h/ft/g >2cm 11308	Surgery	11308	CPT	7817468		Washington Regional Medical Center	outpatient	106	53	AmeriHealth Caritas North Carolina	NC Medicaid	37.27	37.27	92.73
Shv Lesn S/n/h/ft/g >2cm 11308	Shv Lesn S/n/h/ft/g >2cm 11308	Surgery	11308	CPT	7817468		Washington Regional Medical Center	outpatient	106	53	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	37.27	37.27	92.73
Shv Lesn S/n/h/ft/g >2cm 11308	Shv Lesn S/n/h/ft/g >2cm 11308	Surgery	11308	CPT	7817468		Washington Regional Medical Center	outpatient	106	53	WellCare of North Carolina	North Carolina Medicaid/CHIP	37.27	37.27	92.73
Shv Lesn S/n/h/ft/g >2cm 11308	Shv Lesn S/n/h/ft/g >2cm 11308	Surgery	11308	CPT	7817468		Washington Regional Medical Center	outpatient	106	53	Healthy Blue / Blue Cross NC	North Carolina Medicaid	37.27	37.27	92.73
Shv Lesn S/n/h/ft/g >2cm 11308	Shv Lesn S/n/h/ft/g >2cm 11308	Surgery	11308	CPT	7817468		Washington Regional Medical Center	outpatient	106	53	Cigna	North Carolina PPO-PPA Direct	92.73	37.27	92.73
Shv Lesn S/n/h/ft/g >2cm 11308	Shv Lesn S/n/h/ft/g >2cm 11308	Surgery	11308	CPT	7817468		Washington Regional Medical Center	outpatient	106	53	Original Medicare	Traditional Medicare Fee-for-Service	49.82	37.27	92.73
Smp Rep SNATGE 2.5-7.5cm 12002	Smp Rep SNATGE 2.5-7.5cm 12002	Surgery	12002	CPT	1021852		Washington Regional Medical Center	outpatient	493	246.5	Self-Pay	Discounted Cash		127.69	369.75
Smp Rep SNATGE 2.5-7.5cm 12002	Smp Rep SNATGE 2.5-7.5cm 12002	Surgery	12002	CPT	1021852		Washington Regional Medical Center	outpatient	493	246.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	369.75	127.69	369.75
Smp Rep SNATGE 2.5-7.5cm 12002	Smp Rep SNATGE 2.5-7.5cm 12002	Surgery	12002	CPT	1021852		Washington Regional Medical Center	outpatient	493	246.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	216.92	127.69	369.75
Smp Rep SNATGE 2.5-7.5cm 12002	Smp Rep SNATGE 2.5-7.5cm 12002	Surgery	12002	CPT	1021852		Washington Regional Medical Center	outpatient	493	246.5	Humana	Medicare Advantage HMO/PPO/PFFS	231.71	127.69	369.75
Smp Rep SNATGE 2.5-7.5cm 12002	Smp Rep SNATGE 2.5-7.5cm 12002	Surgery	12002	CPT	1021852		Washington Regional Medical Center	outpatient	493	246.5	AmeriHealth Caritas North Carolina	NC Medicaid	173.34	127.69	369.75
Smp Rep SNATGE 2.5-7.5cm 12002	Smp Rep SNATGE 2.5-7.5cm 12002	Surgery	12002	CPT	1021852		Washington Regional Medical Center	outpatient	493	246.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	173.34	127.69	369.75
Smp Rep SNATGE 2.5-7.5cm 12002	Smp Rep SNATGE 2.5-7.5cm 12002	Surgery	12002	CPT	1021852		Washington Regional Medical Center	outpatient	493	246.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	173.34	127.69	369.75
Smp Rep SNATGE 2.5-7.5cm 12002	Smp Rep SNATGE 2.5-7.5cm 12002	Surgery	12002	CPT	1021852		Washington Regional Medical Center	outpatient	493	246.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	173.34	127.69	369.75
Smp Rep SNATGE 2.5-7.5cm 12002	Smp Rep SNATGE 2.5-7.5cm 12002	Surgery	12002	CPT	1021852		Washington Regional Medical Center	outpatient	493	246.5	Cigna	North Carolina PPO-PPA Direct	127.69	127.69	369.75
Smp Rep SNATGE 2.5-7.5cm 12002	Smp Rep SNATGE 2.5-7.5cm 12002	Surgery	12002	CPT	1021852		Washington Regional Medical Center	outpatient	493	246.5	Original Medicare	Traditional Medicare Fee-for-Service	231.71	127.69	369.75
TfrTis F/m/N/a/g/h/f<=10 14040	TfrTis F/m/N/a/g/h/f<=10 14040	Surgery	14040	CPT	2726407		Washington Regional Medical Center	outpatient	1700	850	Self-Pay	Discounted Cash		597.72	1275
TfrTis F/m/N/a/g/h/f<=10 14040	TfrTis F/m/N/a/g/h/f<=10 14040	Surgery	14040	CPT	2726407		Washington Regional Medical Center	outpatient	1700	850	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	1275	597.72	1275
TfrTis F/m/N/a/g/h/f<=10 14040	TfrTis F/m/N/a/g/h/f<=10 14040	Surgery	14040	CPT	2726407		Washington Regional Medical Center	outpatient	1700	850	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	748	597.72	1275
TfrTis F/m/N/a/g/h/f<=10 14040	TfrTis F/m/N/a/g/h/f<=10 14040	Surgery	14040	CPT	2726407		Washington Regional Medical Center	outpatient	1700	850	Humana	Medicare Advantage HMO/PPO/PFFS	799	597.72	1275
TfrTis F/m/N/a/g/h/f<=10 14040	TfrTis F/m/N/a/g/h/f<=10 14040	Surgery	14040	CPT	2726407		Washington Regional Medical Center	outpatient	1700	850	AmeriHealth Caritas North Carolina	NC Medicaid	597.72	597.72	1275
TfrTis F/m/N/a/g/h/f<=10 14040	TfrTis F/m/N/a/g/h/f<=10 14040	Surgery	14040	CPT	2726407		Washington Regional Medical Center	outpatient	1700	850	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	597.72	597.72	1275
TfrTis F/m/N/a/g/h/f<=10 14040	TfrTis F/m/N/a/g/h/f<=10 14040	Surgery	14040	CPT	2726407		Washington Regional Medical Center	outpatient	1700	850	WellCare of North Carolina	North Carolina Medicaid/CHIP	597.72	597.72	1275
TfrTis F/m/N/a/g/h/f<=10 14040	TfrTis F/m/N/a/g/h/f<=10 14040	Surgery	14040	CPT	2726407		Washington Regional Medical Center	outpatient	1700	850	Healthy Blue / Blue Cross NC	North Carolina Medicaid	597.72	597.72	1275
TfrTis F/m/N/a/g/h/f<=10 14040	TfrTis F/m/N/a/g/h/f<=10 14040	Surgery	14040	CPT	2726407		Washington Regional Medical Center	outpatient	1700	850	Cigna	North Carolina PPO-PPA Direct	679.24	597.72	1275
TfrTis F/m/N/a/g/h/f<=10 14040	TfrTis F/m/N/a/g/h/f<=10 14040	Surgery	14040	CPT	2726407		Washington Regional Medical Center	outpatient	1700	850	Original Medicare	Traditional Medicare Fee-for-Service	799	597.72	1275
Treat Finger Frct Each 26746	Treat Finger Frct Each 26746	Surgery	26746	CPT	2726583		Washington Regional Medical Center	outpatient	2907.84	1453.92	Self-Pay	Discounted Cash		523.85	2180.88
Treat Finger Frct Each 26746	Treat Finger Frct Each 26746	Surgery	26746	CPT	2726583		Washington Regional Medical Center	outpatient	2907.84	1453.92	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	2180.88	523.85	2180.88
Treat Finger Frct Each 26746	Treat Finger Frct Each 26746	Surgery	26746	CPT	2726583		Washington Regional Medical Center	outpatient	2907.84	1453.92	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	1279.45	523.85	2180.88
Treat Finger Frct Each 26746	Treat Finger Frct Each 26746	Surgery	26746	CPT	2726583		Washington Regional Medical Center	outpatient	2907.84	1453.92	Humana	Medicare Advantage HMO/PPO/PFFS	1366.68	523.85	2180.88
Treat Finger Frct Each 26746	Treat Finger Frct Each 26746	Surgery	26746	CPT	2726583		Washington Regional Medical Center	outpatient	2907.84	1453.92	AmeriHealth Caritas North Carolina	NC Medicaid	1022.4	523.85	2180.88
Treat Finger Frct Each 26746	Treat Finger Frct Each 26746	Surgery	26746	CPT	2726583		Washington Regional Medical Center	outpatient	2907.84	1453.92	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	1022.4	523.85	2180.88
Treat Finger Frct Each 26746	Treat Finger Frct Each 26746	Surgery	26746	CPT	2726583		Washington Regional Medical Center	outpatient	2907.84	1453.92	WellCare of North Carolina	North Carolina Medicaid/CHIP	1022.4	523.85	2180.88
Treat Finger Frct Each 26746	Treat Finger Frct Each 26746	Surgery	26746	CPT	2726583		Washington Regional Medical Center	outpatient	2907.84	1453.92	Healthy Blue / Blue Cross NC	North Carolina Medicaid	1022.4	523.85	2180.88
Treat Finger Frct Each 26746	Treat Finger Frct Each 26746	Surgery	26746	CPT	2726583		Washington Regional Medical Center	outpatient	2907.84	1453.92	Cigna	North Carolina PPO-PPA Direct	523.85	523.85	2180.88
Treat Finger Frct Each 26746	Treat Finger Frct Each 26746	Surgery	26746	CPT	2726583		Washington Regional Medical Center	outpatient	2907.84	1453.92	Original Medicare	Traditional Medicare Fee-for-Service	1366.68	523.85	2180.88
Trim Skin Lesions Over 4 11057	Trim Skin Lesions Over 4 11057	Surgery	11057	CPT	2726333		Washington Regional Medical Center	outpatient	161	80.5	Self-Pay	Discounted Cash		51.46	120.75
Trim Skin Lesions Over 4 11057	Trim Skin Lesions Over 4 11057	Surgery	11057	CPT	2726333		Washington Regional Medical Center	outpatient	161	80.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	120.75	51.46	120.75
Trim Skin Lesions Over 4 11057	Trim Skin Lesions Over 4 11057	Surgery	11057	CPT	2726333		Washington Regional Medical Center	outpatient	161	80.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	70.84	51.46	120.75
Trim Skin Lesions Over 4 11057	Trim Skin Lesions Over 4 11057	Surgery	11057	CPT	2726333		Washington Regional Medical Center	outpatient	161	80.5	Humana	Medicare Advantage HMO/PPO/PFFS	75.67	51.46	120.75
Trim Skin Lesions Over 4 11057	Trim Skin Lesions Over 4 11057	Surgery	11057	CPT	2726333		Washington Regional Medical Center	outpatient	161	80.5	AmeriHealth Caritas North Carolina	NC Medicaid	56.61	51.46	120.75
Trim Skin Lesions Over 4 11057	Trim Skin Lesions Over 4 11057	Surgery	11057	CPT	2726333		Washington Regional Medical Center	outpatient	161	80.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	56.61	51.46	120.75
Trim Skin Lesions Over 4 11057	Trim Skin Lesions Over 4 11057	Surgery	11057	CPT	2726333		Washington Regional Medical Center	outpatient	161	80.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	56.61	51.46	120.75
Trim Skin Lesions Over 4 11057	Trim Skin Lesions Over 4 11057	Surgery	11057	CPT	2726333		Washington Regional Medical Center	outpatient	161	80.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	56.61	51.46	120.75
Trim Skin Lesions Over 4 11057	Trim Skin Lesions Over 4 11057	Surgery	11057	CPT	2726333		Washington Regional Medical Center	outpatient	161	80.5	Cigna	North Carolina PPO-PPA Direct	51.46	51.46	120.75
Trim Skin Lesions Over 4 11057	Trim Skin Lesions Over 4 11057	Surgery	11057	CPT	2726333		Washington Regional Medical Center	outpatient	161	80.5	Original Medicare	Traditional Medicare Fee-for-Service	75.67	51.46	120.75
TX CARPAL BONE FX W/O MANIP	TX CARPAL BONE FX W/O MANIP	Surgery	25630	CPT	6001204		Washington Regional Medical Center	outpatient	1089	544.5	Self-Pay	Discounted Cash		267.16	816.75
TX CARPAL BONE FX W/O MANIP	TX CARPAL BONE FX W/O MANIP	Surgery	25630	CPT	6001204		Washington Regional Medical Center	outpatient	1089	544.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	816.75	267.16	816.75
TX CARPAL BONE FX W/O MANIP	TX CARPAL BONE FX W/O MANIP	Surgery	25630	CPT	6001204		Washington Regional Medical Center	outpatient	1089	544.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	479.16	267.16	816.75
TX CARPAL BONE FX W/O MANIP	TX CARPAL BONE FX W/O MANIP	Surgery	25630	CPT	6001204		Washington Regional Medical Center	outpatient	1089	544.5	Humana	Medicare Advantage HMO/PPO/PFFS	511.83	267.16	816.75
TX CARPAL BONE FX W/O MANIP	TX CARPAL BONE FX W/O MANIP	Surgery	25630	CPT	6001204		Washington Regional Medical Center	outpatient	1089	544.5	AmeriHealth Caritas North Carolina	NC Medicaid	382.89	267.16	816.75
TX CARPAL BONE FX W/O MANIP	TX CARPAL BONE FX W/O MANIP	Surgery	25630	CPT	6001204		Washington Regional Medical Center	outpatient	1089	544.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	382.89	267.16	816.75
TX CARPAL BONE FX W/O MANIP	TX CARPAL BONE FX W/O MANIP	Surgery	25630	CPT	6001204		Washington Regional Medical Center	outpatient	1089	544.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	382.89	267.16	816.75
TX CARPAL BONE FX W/O MANIP	TX CARPAL BONE FX W/O MANIP	Surgery	25630	CPT	6001204		Washington Regional Medical Center	outpatient	1089	544.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	382.89	267.16	816.75
TX CARPAL BONE FX W/O MANIP	TX CARPAL BONE FX W/O MANIP	Surgery	25630	CPT	6001204		Washington Regional Medical Center	outpatient	1089	544.5	Cigna	North Carolina PPO-PPA Direct	267.16	267.16	816.75
TX CARPAL BONE FX W/O MANIP	TX CARPAL BONE FX W/O MANIP	Surgery	25630	CPT	6001204		Washington Regional Medical Center	outpatient	1089	544.5	Original Medicare	Traditional Medicare Fee-for-Service	511.83	267.16	816.75
TX CARPAL BONE FX W/O MANIP EA	TX CARPAL BONE FX W/O MANIP EA	Surgery	25630	CPT	7501093		Washington Regional Medical Center	outpatient	1089	544.5	Self-Pay	Discounted Cash		267.16	816.75
TX CARPAL BONE FX W/O MANIP EA	TX CARPAL BONE FX W/O MANIP EA	Surgery	25630	CPT	7501093		Washington Regional Medical Center	outpatient	1089	544.5	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	816.75	267.16	816.75
TX CARPAL BONE FX W/O MANIP EA	TX CARPAL BONE FX W/O MANIP EA	Surgery	25630	CPT	7501093		Washington Regional Medical Center	outpatient	1089	544.5	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	479.16	267.16	816.75
TX CARPAL BONE FX W/O MANIP EA	TX CARPAL BONE FX W/O MANIP EA	Surgery	25630	CPT	7501093		Washington Regional Medical Center	outpatient	1089	544.5	Humana	Medicare Advantage HMO/PPO/PFFS	511.83	267.16	816.75
TX CARPAL BONE FX W/O MANIP EA	TX CARPAL BONE FX W/O MANIP EA	Surgery	25630	CPT	7501093		Washington Regional Medical Center	outpatient	1089	544.5	AmeriHealth Caritas North Carolina	NC Medicaid	382.89	267.16	816.75
TX CARPAL BONE FX W/O MANIP EA	TX CARPAL BONE FX W/O MANIP EA	Surgery	25630	CPT	7501093		Washington Regional Medical Center	outpatient	1089	544.5	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	382.89	267.16	816.75
TX CARPAL BONE FX W/O MANIP EA	TX CARPAL BONE FX W/O MANIP EA	Surgery	25630	CPT	7501093		Washington Regional Medical Center	outpatient	1089	544.5	WellCare of North Carolina	North Carolina Medicaid/CHIP	382.89	267.16	816.75
TX CARPAL BONE FX W/O MANIP EA	TX CARPAL BONE FX W/O MANIP EA	Surgery	25630	CPT	7501093		Washington Regional Medical Center	outpatient	1089	544.5	Healthy Blue / Blue Cross NC	North Carolina Medicaid	382.89	267.16	816.75
TX CARPAL BONE FX W/O MANIP EA	TX CARPAL BONE FX W/O MANIP EA	Surgery	25630	CPT	7501093		Washington Regional Medical Center	outpatient	1089	544.5	Cigna	North Carolina PPO-PPA Direct	267.16	267.16	816.75
TX CARPAL BONE FX W/O MANIP EA	TX CARPAL BONE FX W/O MANIP EA	Surgery	25630	CPT	7501093		Washington Regional Medical Center	outpatient	1089	544.5	Original Medicare	Traditional Medicare Fee-for-Service	511.83	267.16	816.75
TX METACARPAL FX W/ MANIP	TX METACARPAL FX W/ MANIP	Surgery	26605	CPT	6001209		Washington Regional Medical Center	outpatient	1196	598	Self-Pay	Discounted Cash		296.25	897
TX METACARPAL FX W/ MANIP	TX METACARPAL FX W/ MANIP	Surgery	26605	CPT	6001209		Washington Regional Medical Center	outpatient	1196	598	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	897	296.25	897
TX METACARPAL FX W/ MANIP	TX METACARPAL FX W/ MANIP	Surgery	26605	CPT	6001209		Washington Regional Medical Center	outpatient	1196	598	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	526.24	296.25	897
TX METACARPAL FX W/ MANIP	TX METACARPAL FX W/ MANIP	Surgery	26605	CPT	6001209		Washington Regional Medical Center	outpatient	1196	598	Humana	Medicare Advantage HMO/PPO/PFFS	562.12	296.25	897
TX METACARPAL FX W/ MANIP	TX METACARPAL FX W/ MANIP	Surgery	26605	CPT	6001209		Washington Regional Medical Center	outpatient	1196	598	AmeriHealth Caritas North Carolina	NC Medicaid	420.51	296.25	897
TX METACARPAL FX W/ MANIP	TX METACARPAL FX W/ MANIP	Surgery	26605	CPT	6001209		Washington Regional Medical Center	outpatient	1196	598	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	420.51	296.25	897
TX METACARPAL FX W/ MANIP	TX METACARPAL FX W/ MANIP	Surgery	26605	CPT	6001209		Washington Regional Medical Center	outpatient	1196	598	WellCare of North Carolina	North Carolina Medicaid/CHIP	420.51	296.25	897
TX METACARPAL FX W/ MANIP	TX METACARPAL FX W/ MANIP	Surgery	26605	CPT	6001209		Washington Regional Medical Center	outpatient	1196	598	Healthy Blue / Blue Cross NC	North Carolina Medicaid	420.51	296.25	897
TX METACARPAL FX W/ MANIP	TX METACARPAL FX W/ MANIP	Surgery	26605	CPT	6001209		Washington Regional Medical Center	outpatient	1196	598	Cigna	North Carolina PPO-PPA Direct	296.25	296.25	897
TX METACARPAL FX W/ MANIP	TX METACARPAL FX W/ MANIP	Surgery	26605	CPT	6001209		Washington Regional Medical Center	outpatient	1196	598	Original Medicare	Traditional Medicare Fee-for-Service	562.12	296.25	897
TX METATARSAL FX W/	TX METATARSAL FX W/	Surgery	28485	CPT	7501117		Washington Regional Medical Center	outpatient	802.04	401.02	Self-Pay	Discounted Cash		282	601.53
TX METATARSAL FX W/	TX METATARSAL FX W/	Surgery	28485	CPT	7501117		Washington Regional Medical Center	outpatient	802.04	401.02	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	601.53	282	601.53
TX METATARSAL FX W/	TX METATARSAL FX W/	Surgery	28485	CPT	7501117		Washington Regional Medical Center	outpatient	802.04	401.02	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	352.9	282	601.53
TX METATARSAL FX W/	TX METATARSAL FX W/	Surgery	28485	CPT	7501117		Washington Regional Medical Center	outpatient	802.04	401.02	Humana	Medicare Advantage HMO/PPO/PFFS	376.96	282	601.53
TX METATARSAL FX W/	TX METATARSAL FX W/	Surgery	28485	CPT	7501117		Washington Regional Medical Center	outpatient	802.04	401.02	AmeriHealth Caritas North Carolina	NC Medicaid	282	282	601.53
TX METATARSAL FX W/	TX METATARSAL FX W/	Surgery	28485	CPT	7501117		Washington Regional Medical Center	outpatient	802.04	401.02	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	282	282	601.53
TX METATARSAL FX W/	TX METATARSAL FX W/	Surgery	28485	CPT	7501117		Washington Regional Medical Center	outpatient	802.04	401.02	WellCare of North Carolina	North Carolina Medicaid/CHIP	282	282	601.53
TX METATARSAL FX W/	TX METATARSAL FX W/	Surgery	28485	CPT	7501117		Washington Regional Medical Center	outpatient	802.04	401.02	Healthy Blue / Blue Cross NC	North Carolina Medicaid	282	282	601.53
TX METATARSAL FX W/	TX METATARSAL FX W/	Surgery	28485	CPT	7501117		Washington Regional Medical Center	outpatient	802.04	401.02	Cigna	North Carolina PPO-PPA Direct	512.22	282	601.53
TX METATARSAL FX W/	TX METATARSAL FX W/	Surgery	28485	CPT	7501117		Washington Regional Medical Center	outpatient	802.04	401.02	Original Medicare	Traditional Medicare Fee-for-Service	376.96	282	601.53
TX RADIAL/ULNAR FX W/O MI	TX RADIAL/ULNAR FX W/O MI	Surgery	25560	CPT	7501090		Washington Regional Medical Center	outpatient	1014	507	Self-Pay	Discounted Cash		229.94	760.5
TX RADIAL/ULNAR FX W/O MI	TX RADIAL/ULNAR FX W/O MI	Surgery	25560	CPT	7501090		Washington Regional Medical Center	outpatient	1014	507	Aetna	Commercial Gatekeeper and Non-Gatekeeper Products	760.5	229.94	760.5
TX RADIAL/ULNAR FX W/O MI	TX RADIAL/ULNAR FX W/O MI	Surgery	25560	CPT	7501090		Washington Regional Medical Center	outpatient	1014	507	Blue Cross and Blue Shield of North Carolina	Blue Medicare HMO/PPO	446.16	229.94	760.5
TX RADIAL/ULNAR FX W/O MI	TX RADIAL/ULNAR FX W/O MI	Surgery	25560	CPT	7501090		Washington Regional Medical Center	outpatient	1014	507	Humana	Medicare Advantage HMO/PPO/PFFS	476.58	229.94	760.5
TX RADIAL/ULNAR FX W/O MI	TX RADIAL/ULNAR FX W/O MI	Surgery	25560	CPT	7501090		Washington Regional Medical Center	outpatient	1014	507	AmeriHealth Caritas North Carolina	NC Medicaid	356.52	229.94	760.5
TX RADIAL/ULNAR FX W/O MI	TX RADIAL/ULNAR FX W/O MI	Surgery	25560	CPT	7501090		Washington Regional Medical Center	outpatient	1014	507	UnitedHealthcare Community Plan	North Carolina Medicaid and CHIP	356.52	229.94	760.5
TX RADIAL/ULNAR FX W/O MI	TX RADIAL/ULNAR FX W/O MI	Surgery	25560	CPT	7501090		Washington Regional Medical Center	outpatient	1014	507	WellCare of North Carolina	North Carolina Medicaid/CHIP	356.52	229.94	760.5
TX RADIAL/ULNAR FX W/O MI	TX RADIAL/ULNAR FX W/O MI	Surgery	25560	CPT	7501090		Washington Regional Medical Center	outpatient	1014	507	Healthy Blue / Blue Cross NC	North Carolina Medicaid	356.52	229.94	760.5
TX RADIAL/ULNAR FX W/O MI	TX RADIAL/ULNAR FX W/O MI	Surgery	25560	CPT	7501090		Washington Regional Medical Center	outpatient	1014	507	Cigna	North Carolina PPO-PPA Direct	229.94	229.94	760.5
TX RADIAL/ULNAR FX W/O MI	TX RADIAL/ULNAR FX W/O MI	Surgery	25560	CPT	7501090		Washington Regional Medical Center	outpatient	1014	507	Original Medicare	Traditional Medicare Fee-for-Service	476.58	229.94	760.5