HHS Office of Inspector General report - oig.hhs.govoig.hhs.gov/oei/reports/oei-07-11-00010.pdf · Agency Comments and Office of Inspector General Response ... lowest insurer’s

Department of Health and Human Services

OFFICE OF INSPECTOR GENERAL

OMPARING AB EST

PAYMENT

RATES MEDICARE

COULD ACHIEVE

SUBSTANTIAL SAVINGS

Daniel R Levinson Inspector General

June 2013

OEI-07-11-00010

EXECUTIVE SUMMARY - COMPARING LAB TEST PAYMENT RATES MEDICARE COULD ACHIEVE SUBSTANTIAL SAVINGS OEI-07-11-00010

WHY WE DID THIS STUDY

Medicare is the largest payer of clinical laboratory (lab) services in the Nation It paid approximately $82 billion for lab tests in 2010 which accounted for 3 percent of all Medicare Part B payments Prior to this evaluation there had not been a comparison of Medicare payment rates to those of other health care service payers Such a comparison will help ensure that Medicare is a prudent purchaser of lab services

HOW WE DID THIS STUDY

We collected payment data from 50 State Medicaid programs and 3 Federal Employees Health Benefits (FEHB) plans that pay for lab tests on a fee-for-service basis We requested the payment rates in effect from January 1 through March 31 2011 for 20 lab tests For each lab test in each geographic area represented on the Medicare Clinical Laboratory Fee Schedule (CLFS) we compared Medicare paid claims with the State Medicaid program fee schedule amount and FEHB plan median claim payment amounts We surveyed State Medicaid programs and FEHB plans to determine how their lab test fee schedules or payment rates were formulated whether a copayment was charged to the patient and whether lab test charges counted towards a memberrsquos deductible

WHAT WE FOUND

In 2011 Medicare paid between 18 and 30 percent more than other insurers for 20 high-volume andor high-expenditure lab tests Medicare could have saved $910 million or 38 percent on these lab tests if it had paid providers at the lowest established rate in each geographic area State Medicaid programs and 83 percent of FEHB plans use the Medicare CLFS as a basis for establishing their own fee schedules and payment rates although most pay less However unlike Medicare FEHB programs incorporate factors such as competitor information changes in technology used in performing lab tests and provider requests in their payment rates Some State Medicaid programs and FEHB plans required copayments for lab tests which in effect lowered the costs of lab tests for the insurer

WHAT WE RECOMMEND

We recommend that the Centers for Medicare amp Medicaid Services (CMS) seek legislation that would allow it to establish lower payment rates for lab tests and consider seeking legislation to institute copayments and deductibles for lab tests In its comments CMS stated that it is exploring whether it has authority under current statute to revise payments for lab tests consistent with OIGrsquos recommendation and that a proposal to establish ldquodeductibles and coinsurancerdquo for lab tests is not included in the fiscal year 2014 Presidentrsquos Budget

TABLE OF CONTENTS

Objectives 1

Background1

Methodology4

Findings9

In 2011 Medicare paid between 18 and 30 percent more for 20 lab tests than other insurers9

Medicare could have saved $910 million in 2011 if it had paid the lowest insurerrsquos payment rate for 20 lab tests 10

Medicarersquos payment rate methodology does not take into account technological and market changes 10

Unlike other insurers reviewed Medicare does not require copayments and deductibles for lab tests 11

Conclusion and Recommendations 13

Agency Comments and Office of Inspector General Response 15

Appendixes 16

A Lab Tests Included in Review 16

B Comparison of Medicare-Allowed Amounts for Lab Tests With Rates of Other Insurers 18

C Medicare Clinical Laboratory Fee Schedule State Medicaid Program Fee Schedule and Federal Employees Health Benefits Program Median Payment Rates for Selected Laboratory Test Codes23

D Potential Savings to Medicare 44

E Agency Comments 46

Acknowledgments48

OBJECTIVES To determine

1 the extent to which 2011 Medicare payment rates for 20 selected laboratory (lab) tests vary from those of State Medicaid programs and Federal Employees Health Benefits (FEHB) plans

2 the amount Medicare could have saved if it had paid a rate equal to the lowest insurerrsquos payment rate for the 20 selected lab tests

3 how the methods for establishing Medicare lab test payment rates vary from those of State Medicaid programs and FEHB plans and

4 the extent to which State Medicaid programs and FEHB plans require copayments and deductibles for lab tests

BACKGROUND Medicare is the largest payer of clinical lab services in the Nation It paid approximately $82 billion for lab tests in 2010 which accounted for 3 percent of all Medicare Part B payments1 Prior to this evaluation there had not been a comparison of Medicare payment rates for clinical lab services with payment rates for other health care service payers Such a comparison will help ensure that Medicare is a prudent purchaser of lab services Medicarersquos methods for establishing payment rates for lab services have remained largely unchanged since 1984

Medicare Part B Coverage and Payment for Lab Tests Clinical diagnostic lab tests are performed on specimens taken from the human body Lab tests provide information integral to preventing diagnosing and treating disease Most lab tests are conducted in hospital physician-office or independent laboratories Medicare Part B covers most lab tests and pays 100 percent of allowable charges Medicare beneficiaries do not pay copayments or deductibles for lab tests2

Each lab submits claims to the Medicare Administrative Contractor (MAC) responsible for the area in which it is located Although 15 MACs have largely replaced Medicare Part B claims payment carriers (carriers) that corresponded closely to State borders MACs continue to administer the same payment policies created by the former 57 carriers as explained below

1 Centers for Medicare amp Medicaid Services (CMS) Data Compendium Table II3 Accessed at httpwwwcmsgovDataCompendium on June 8 2012 2 Social Security Act (SSA) sectsect 1833(a)(1)(D) and (b)(3) and 1866(a)(2)(A)

Comparing Lab Test Payment Rates Medicare Could Achieve Substantial Savings (OEI-07-11-00010) 1

The Clinical Laboratory Fee Schedule Initial Establishment The Deficit Reduction Act of 1984 (DRA) mandated that payment rates be established for lab tests on a regional statewide or carrier basis3 The DRA also mandated that the Consumer Price Index for All Urban Consumers (CPI-U) be used annually to adjust rates for inflation Beginning July 1 1984 each carrier established its own payment rates on the basis of prevailing charges for lab tests in its locality These payment rates are collectively known as the Clinical Laboratory Fee Schedule (CLFS)

National Limitation Amount The Consolidated Omnibus Budget Reconciliation Act of 1985 mandated a national limitation amount (NLA) for lab tests4 Between July 1 1986 and March 31 1988 the NLA capped carrier rates at 115 percent of the median carrier rate for each lab test5 For example if the median carrier rate for a particular lab test was $100 the NLA capped carrier rates at $115 Carriers could establish rates at or below the NLA but could not exceed it

In an effort to contain costs from 1988 through 1998 Congress incrementally lowered the NLA as a percentage of the national median carrier rate6 Since 1998 the NLA has been set at 74 percent of the median carrier rate for each lab test7 Under the CLFS MACs pay laboratories the lower of the laboratoriesrsquo actual charges or the carrier rate as capped by the NLA8

CMS publishes an updated CLFS at least annually containing payment rates based on the 57 jurisdictions of the former carriers9 The 2011 CLFS contains the median carrier rate the NLA and each carrierrsquos rate for 1140 unique lab tests identified by the Healthcare Common Procedure

3 PL 98-369 sect 2303 4 PL 99-272 sect 9303(b) 5 SSA sect 1833(h)(4)(B)(i) 6 SSA sect 1833(h)(4)(B) 7 SSA sect 1833(h)(4)(B)(viii) For new lab tests for which an NLA was not established before January 1 2001 the NLA is set at 100 percent of the median 8 SSA sect 1833(a)(1)(D)(i) 9 The 57 jurisdictions include the 50 States the District of Columbia and Puerto Rico California Kansas and Missouri are each divided into 2 jurisdictions New York is divided into 3 jurisdictions

Coding System (HCPCS)10 As an example HCPCS 82607 represents a lab test that checks the level of vitamin B-12 in blood The median carrier rate for this test is $2866 and the NLA is 74 percent of this figure or $2121 The payment rate for 51 of the carrier jurisdictions is the NLA ($2121) The payment rates for the remaining six carrier jurisdictions are less than the NLA ranging from $1467 to $2105

Adjustments to the CLFS Since the establishment of the CLFS various laws have changed the calculation of the payment rates on the CLFS (see Table 1)

Table 1 Adjustments to CLFS Payment Rates for Lab Tests

Year Legislation Effect on the CLFS

Medicare Prescription Drug Improvement and Modernization Act of 2003 PL 108-173 sectsect 628 and 302(b)

Eliminated the CPI-U adjustments for 2004 through 2008 mandated that CMS implement a demonstration project to explore whether competitive bidding could reduce rates for lab tests below Medicarersquos fee schedule rates

Medicare Improvements for Patients and Providers Act of 2008 PL 110-275 sect 145(a) and (b)

Repealed CMSrsquos authority for a competitive bidding demonstration lowered the CPI-U adjustment by 05 percentage points from 2009 through 2013

2010 Patient Protection and Affordable Care Act PL 111-148 sect 3401(l)

Repealed the 05-percentage point reduction in the CPI-U beginning in 2011 and replaced it with a reduction equal to the 10-year moving average of annual multifactor productivity which is determined by the Bureau of Labor Statistics reduced the CLFS by an additional 175 percentage points in years 2011 through 2015

CMS has only limited authority to make adjustments to CLFS payment rates11 Any additional changes to the CLFS require legislative action

Limits on Medicaid Payment for Lab Tests Section 1903(i)(7) of the SSA prohibits State Medicaid program payments for lab tests that exceed the Medicare payment amount Chapter 6

10 HCPCS Level 1 numerical codes are identical to CPT codes and are used by CMS when services and procedures involve Medicare beneficiaries (eg 70405) The five character codes and descriptions included in this report are obtained from Current Procedural Terminology (CPTreg) copyright 2011 by the American Medical Association (AMA) CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures Any use of CPT outside of this report should refer to the most current version of the Current Procedural Terminology available from AMA Applicable FARSDFARS apply 11 SSA sect 1833(h)(2)(A)(i) provides that the Secretary may make adjustments to CLFS payment rates that are justified by technological changes SSA sect 1833(h)(2)(B) provides for adjustments or exceptions to the CLFS ldquoto assure adequate reimbursement of emergency laboratory tests needed for the provision of bona fide emergency services and certain low-volume high-cost tests where highly sophisticated equipment or extremely skilled personnel are necessary to assure qualityrdquo

sect 63002 of the CMS State Medicaid Manual states that Medicaid reimbursement for clinical diagnostic lab tests may not exceed the amount that Medicare recognizes for such tests The section provides eight exceptions that pertain to lab tests furnished by certain types of facilities (eg hospices) andor paid for under the end stage renal disease composite rate

FEHB Payment for Lab Tests FEHB plans contract with local plans and provider networks to provide services to members including lab tests Within these contracts FEHB plans negotiate payment rates Although Federal regulation limits the amount that providers may charge for inpatient hospital and physician services to the Medicare amount no such limits exist for lab tests12

Related Reports A 2000 Institute of Medicine (IOM) report found that Medicarersquos fee schedule for lab tests and its methodology for setting payment rates had not evolved to account for technological and market changes IOM recommended that Medicare payments for lab tests ldquobe based on a single rational national fee schedulerdquo adjusted for geographic location to account for differences in costs of labor and supplies13

In 2009 the Office of Inspector General (OIG) found that 83 percent of carrier payment rates were at the NLA14 OIG found that the variation in carrier payment rates did not appear to reflect geographic cost differences and that varying methods were used to update carrier payment rates OIG recommended that CMS seek legislation that would allow it to set accurate and reasonable payment rates for lab tests In its response CMS noted that the Presidentrsquos budget for fiscal year 2010 did not include any proposals for amending the payment methodology for lab tests therefore CMS did not concur with this recommendation CMS further stated that it would consider the recommendation as it continued to monitor the effects of its payment policies CMS staff confirmed in early 2012 that it had no initiative underway to revamp the payment rate structure for lab tests

METHODOLOGY

Scope We evaluated Medicare paid claims for CLFS lab tests during 2011 For CLFS lab tests we included the top 15 lab tests by volume and by

12 5 CFR sect 890905 13 IOM Medicare Laboratory Payment Policy Now and in the Future January 2000 Accessed at httpiomeduReports2000 on June 8 2012 14 OIG Variation in the Clinical Laboratory Fee Schedule OEI-05-08-00400 July 2009

expenditure in 2010 the most recent data available at the time of our evaluation design Because of overlap between these 2 groups of lab tests a total of 20 tests were included in this evaluation These tests accounted for 47 percent of the volume and 56 percent of the expenditures for CLFS lab tests reimbursed by Medicare in 2010

To ensure equitable comparisons we compared the Medicare CLFS payment rates only to those under State Medicaid and selected FEHB fee-for-service health care programs We did not compare Medicare fee-for-service payment rates to rates paid by managed care plans because managed care models typically involve an assumption of financial risk by providers Also our comparison of lab test prices used the fee schedule amounts for Medicaid programs and payment rates for FEHB plans The fee schedule amounts for Medicaid programs and payment rates for FEHB plans do not reflect copayments and deductibles because those are factored in only when claims are paid

Data Collection From August through October 2011 we collected data from 50 State Medicaid programs and 3 fee-for-service FEHB plans15 We requested the fee schedule amounts or payment rates in effect from January 1 through March 31 2011 for 20 lab tests as shown in Appendix A We surveyed State Medicaid programs and FEHB plans regarding how their lab test fee schedule or payment rates were formulated whether a copayment was charged to the patient and whether lab test charges counted towards a memberrsquos deductible

We received fee schedule amounts and survey responses from all 50 State Medicaid programs State Medicaid programs provided their fee schedules for lab tests representing the maximum payment rate allowed for each test (For actual claims providers could have billed for less than the fee schedule amounts)

We received payment rates and survey responses from the three selected FEHB plans These three plans provide coverage to 90 percent of fee-for-service enrollees in the FEHB program Each of these national plans provides services through local plans and networks Within a single national plan local plans and networks may have differing payment rates The FEHB plans provided us with first-quarter 2011 median claim payment amounts representing all of their local plans and networks by

15 Staff from the Tennessee Medicaid program stated that 100 percent of recipients are enrolled in managed care plans therefore Tennessee does not pay for any lab tests on a fee-for-service basis We did not include the Tennessee Medicaid program in our data collection We included the District of Columbia for a total of 50 State Medicaid programs

membersrsquo States of residence However they did not provide survey responses regarding how lab test payment rates were formulated for each individual plan or network In total we received surveys from 29 of 58 FEHB local plans andor networks

Payment Rate Comparisons We used the population of Medicare claims for 20 lab test codes for tests performed in physician offices and independent laboratories during 2011 For each lab test in each geographic area we compared the Medicare-allowed amount with the State Medicaid program fee schedule amount and each of the three FEHB planrsquos median claim payment rates16

Insurers reported State-specific payment rates therefore we were able to make equitable comparisons across States

Our approach provides a conservative estimate of potential savings to the Medicare program because using Medicaid claim payment amounts or an FEHB planrsquos lowest rate could produce greater differences in comparison to Medicare-allowed amounts Table 2 summarizes the data sources used for the comparisons

Table 2 Data Sources Used in Payment Rate Comparisons

Insurer Data Source Description

Medicare CMS National Claims History file

Allowed paid claims during 2011

Medicaid 50 State Medicaid programs Fee schedule amounts in effect during the first quarter of 2011

FEHB All local plans and networks within three FEHB plans

Median allowed payment rates for claims with dates of service during the first quarter 2011 for each of the three FEHB plans

Source OIG data collection 2012

We reviewed payment rates for 20 lab tests in each of 56 geographic jurisdictions for a total of 1120 potential comparisons17 However not all insurers reported a payment rate for every lab test in each geographic jurisdiction therefore the Medicare-allowed amounts used in the comparisons vary by insurer Table 3 shows the number of tests for which insurers reported payment rates

16 We excluded Medicare claims submitted by providers in geographic areas other than the 50 States and the District of Columbia To ensure equitable comparisons we excluded claims paid by the contractor that pays claims for the Railroad Retirement Board because this contractor pays claims nationwide rather than in a specific geographic area 17 We did not include Puerto Rico in our analysis therefore we compared payment rates in 56 of the 57 jurisdictions represented on the Medicare CLFS

Table 3 Number of Lab Test Payment Rates Reported by Insurers and

Medicare-Allowed Amount

Insurer Number of Lab Test Payment

2011 Medicare-Allowed

Amount Medicaid 1097 $2355233694

FEHB 1 1054 $2406800929

FEHB 2 1082 $2410847338

FEHB 3 1119 $2416397192

Savings Calculation We conducted a claim-by-claim analysis to calculate the potential savings to Medicare if it had paid providers at the lowest established rate in each geographic area for each of the 20 reviewed tests For example the amount Medicare paid for an iron binding test (HCPCS code 83550) performed in Connecticut was compared with the fee schedule rate for the Connecticut Medicaid program and with the median allowed claim payment rate for each of three FEHB plans for members in Connecticut

Neither the Medicaid nor FEHB plan rates reflected copayments or deductibles because we were using Medicaid fee schedules and FEHB payment rates not the amounts the program and plans actually paid for these tests We subtracted the lowest available rate from the Medicare-allowed amount to calculate the potential savings to Medicare for that claim Table 4 shows this calculation in detail

Table 4 Example Savings Calculation for an Iron Binding Test

HCPCS Code

Insurer Payment

Lowest Available

Potential Savings to

Medicare

Medicare Medicaid FEHB 1 FEHB 2 FEHB 3

$1230 $1160 $1660 $1228 $751

$751 $1230 minus $751

= $479

We summed the savings for each of the claims to calculate the total potential savings to Medicare If the Medicare claim was paid at or below the lowest available rate it was not included in the savings calculation

Limitations On the basis of the timing of our data collection we collected fee schedule amounts and payment rates in effect for the period January 1 through March 31 2011 from State Medicaid and FEHB programs We applied these payment rates to Medicare claims for all of 2011 It is possible that

State Medicaid or FEHB programs obtained different payment rates during April 1 through December 31 2011 which would produce a different calculation of Medicare savings

Standards This study was conducted in accordance with the Quality Standards for Inspection and Evaluation issued by the Council of the Inspectors General on Integrity and Efficiency

$2500000000

$2000000000

$1500000000

Allowed Amount When Insurer Had Lower Price Than Medicare

$1000000000

$2355 Billion

$1966 Billion

$2407 Billion

$2046 Billion

$2411 Billion

$1854 Billion

$2416 Billion

$1853 Billion

Medicaid FEHB 1 FEHB 2 FEHB 3 (20 More) (18 More) (30 More) (30 More)

Health Insurers

FINDINGS

In 2011 Medicare paid between 18 and 30 percent more for 20 lab tests than other insurers

We reviewed payment rates for 20 lab tests in each of 56 geographic jurisdictions Figure 1 shows the dollar amounts that Medicare paid for lab tests in 2011 compared with the dollar amounts that Medicare would have paid if it had paid at the rates that State Medicaid and FEHB plans paid for the same tests on the basis of their fee schedule amounts or payment rates

Figure 1 Comparison of Medicare-Allowed Amounts for Lab Tests With

Rates of Other Insurers

Note Insurers did not report payment rates for all lab tests in all jurisdictions therefore we could not make all 1120 comparisons for each insurer Source OIG data collection 2012

When we compared payment rates for specific tests in specific jurisdictions the smallest price variation in which Medicare paid more than State Medicaid programs for lab tests was $001 (HCPCS 85025 in Montana) and the largest price variation was $3498 (HCPCS 83970 in Kansas) Among FEHB plans the smallest price variation in which Medicare paid more was $001 (HCPCS 80048 in Tennessee) and the largest was $4227 (HCPCS 83880 in Texas) Appendix B Tables B-1 through B-4 provides more detail on the number of lab tests and allowed amount for each of the 20 reviewed tests for each insurer For a complete list of payment rates reported by health insurers for this evaluation see Appendix C

Medicare could have saved $910 million in 2011 if it had paid the lowest insurerrsquos payment rate for 20 lab tests

Of the 4 insurers we reviewed at least 1 paid a lower rate than Medicare on approximately 94 percent of the 1120 price comparisons we performed Table 5 shows the distribution of lab tests paid by other insurers in relation to Medicare

Table 5 Lab Tests Paid by Other Insurers in Relation to Medicare

Insurer

Number and Percentage of

Tests That Insurer Paid

Above Medicare Rates

Tests That Insurer Paid at

Medicare Rates

Below Medicare Rates

Number of Tests Not Paid

by Insurer

Medicaid 65 6 95 9 937 85 23

FEHB 1 402 38 6 1 646 61 66

FEHB 2 486 45 1 lt1 595 55 38

FEHB 3 506 45 9 1 604 54 1

If Medicare had paid providers for lab tests at the lowest established rates among the insurers we surveyed it could have paid 38 percent less saving $910 million For example Medicare paid approximately $348 million for 148 million commonly performed thyroid function tests (HCPCS Code 84443) during 2011 If Medicare had paid providers for these tests at the lowest established rate among the insurers we surveyed it could have saved approximately $140 million or 40 percent18 Appendix D shows the potential savings that Medicare could achieve for each of the 20 tests reviewed using the lowest rate available

Medicarersquos payment rate methodology does not take into account technological and market changes

Medicarersquos payment rates for lab tests were established in 1984 on the basis of prevailing charges for lab tests in each Medicare carrier jurisdiction Since that time legislation has revised the rates by making uniform percentage adjustments to every test on the CLFS CMS has only

18 Providers submitted and Medicare paid a rate lower than the lowest established rate for approximately 296000 tests

limited authority to make adjustments to CLFS payment rates19 Any additional changes to the CLFS require legislative action

As the largest health insurer in the United States Medicare has great influence on the actions of other health care insurers For example Federal law prohibits State Medicaid program payments that exceed the Medicare payment amount for lab tests20 Eighty-three percent (24 of 29) of responding local FEHB plans and networks reported that they use the Medicare CLFS as a basis for establishing their own fee schedules and payment rates

However State Medicaid programs and local FEHB plans reported that they consider factors when establishing payment rates for lab tests that Medicare does not consider For example eight Medicaid plans and four local FEHB plans reported that technological changes (eg benchmarking payment rates for new tests to the actual cost of performing them) are taken into account when establishing payment rates Thirteen local FEHB plans reported taking into account market considerations such as competitor information membership size and market analysis Other factors reported by State Medicaid programs and FEHB plans include provider requests to review the adequacy of a payment rate for a certain lab test and legislative andor budgetary changes

Unlike other insurers reviewed Medicare does not require copayments and deductibles for lab tests

Beneficiaries enrolled in fee-for-service Medicare do not pay copayments for lab tests as they do for other Medicare Part B services (eg physician visits) nor are lab tests subject to a deductible21 In comparison 11 State Medicaid programs reported requiring copayments for lab tests in at least 1 program or recipient category22

The amount of the copayment varied from 50 cents to $10 however certain recipient categories were exempt from the copayment For example the Colorado and Florida State Medicaid programs reported requiring a $1 copayment with exemptions for pregnant women and recipients living in nursing facilities In other States (eg Kentucky and Missouri) the copayment was inclusive of all services rendered by the same provider on a single date of service (eg a lab test and a doctorrsquos office visit)

19 See note 11 20 SSA sect 1903(i)(7) 21 SSA sectsect 1833(a)(1)(D) and (b)(3) and 1866(a)(2)(A) 22 The 11 State Medicaid programs were Arkansas Colorado Florida Iowa Kentucky Maine Missouri New Jersey New York South Dakota and Wisconsin

Each of the three FEHB plans offered multiple coverage options for members with varying copayment amounts among these options For example one FEHB planrsquos ldquostandardrdquo coverage option had a copayment of 15 percent of the providerrsquos allowed charges for lab tests while another planrsquos ldquobasicrdquo coverage option had no copayment For another FEHB planrsquos ldquohigh deductiblerdquo coverage option the copayment was a flat $15 when the tests were not part of a doctorrsquos office visit

Two of the three FEHB plans had an option to avoid member copayments by offering ldquolab cardsrdquo which are issued to members separately from the FEHB planrsquos health insurance identification cards When members went to specified lab collection sites or requested that their physicians send their lab specimens to the specified laboratories the members incurred no out-of-pocket costs When members chose to have their lab tests performed elsewhere the tests were subject to copayments and deductibles

CONCLUSION AND RECOMMENDATIONS In 2011 Medicare paid between 18 and 30 percent more for 20 lab tests than other insurers Medicare could have saved $910 million or 38 percent in 2011 if it had paid the same rate as the lowest paying insurer surveyed for each lab test in each geographic location Achieving lower rates is possible because State Medicaid and FEHB lab test providers accepted these lower rates for lab tests

State Medicaid programs and FEHB plans use the Medicare CLFS as a basis for establishing their own fee schedules and payment rates but most pay less Unlike Medicare FEHB programs incorporate factors such as competitor information changes in technology used in performing lab tests and provider requests Some State Medicaid programs and FEHB plans required copayments for lab tests which in effect lowered the costs of lab tests for the insurer

This report builds on previous OIG evaluations regarding lab test payment rates A 2009 OIG report also recommended changes to the structure of lab test payment rates In that report OIG found that 83 percent of carrier payment rates were at the NLA The variation in carrier payment rates did not appear to reflect geographic cost differences and varying methods were used to update carrier payment rates OIG recommended that CMS seek legislation that would allow it to set accurate and reasonable payment rates for lab tests At that time CMS did not concur with this recommendation but stated that it would consider the recommendation as it continued to monitor the effects of its payment policies This report provides further evidence that the lab test payment rate structure is outdated and should be changed

We recommend that CMS

Seek Legislation That Would Allow CMS To Establish Lower Payment Rates for Lab Tests

CMS could seek legislation that would provide for cost-saving measures such as

conducting demonstration programs such as competitive bidding (ie soliciting bids from lab test providers to obtain market rates) or entering into provider agreements (ie obtaining discounted rates from a small number of providers based on high lab test volume) and

including the ability to make adjustments to payment rates on an individual test basis to account for cost decreases due to technological changes and other factors

Consider Seeking Legislation To Institute Copayments and Deductibles for Lab Tests

Given that 11 State Medicaid programs and all three FEHB plans require copayments for lab tests in certain circumstances CMS may want to consider whether copayments and deductibles for lab tests are appropriate for Medicare beneficiaries We understand that Medicaid programs waive copayments for certain recipient categories and that two FEHB plans offer programs that motivate members to use certain lab test providers to avoid copayments The concept of beneficiary copayments and deductibles is used broadly for other types of services in Medicare requiring them could lead to cost savings

AGENCY COMMENTS AND OFFICE OF INSPECTOR GENERAL RESPONSE CMS did not state whether it concurred or nonconcurred with OIGrsquos recommendations Regarding the first recommendation CMS stated that it is exploring whether it has authority under the current statute to revise payments for lab tests consistent with the recommendation Regarding the second recommendation CMS stated that legislation would be required to establish ldquodeductibles and coinsurancerdquo for lab tests and that such a proposal is not included in the fiscal year 2014 Presidentrsquos Budget We ask that in its final management decision CMS more clearly indicate whether it concurs with our recommendations and what steps if any it will take to implement them

We did not make any changes to the report based on CMSrsquos comments The full text of CMSrsquos comments is provided in Appendix E

APPENDIX A Lab Tests Included in Review

HCPCS Code23 Description

Number of

Medicare-Allowed Tests in

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

2011 Medicare National

Limitation Amount per Test

80048 Metabolic panel total calcium

9355762 23 $94325286 19 $1191

80053 Comprehensive metabolic panel

27232042 66 $319935253 65 $1487

80061 Lipid panel 20970947 51 $310596151 63 $1885

81001 Urinalysis automated with microscopy

6709626 16 $30435748 06 $445

81002 Urinalysis nonautomated without microscopy

4416987 11 $16008487 03 $360

81003 Urinalysis automated without microscopy

4805501 12 $15435365 03 $316

82306 Vitamin D 25 hydroxy 5333420 13 $223366966 46 $4166

82570 Assay of urine creatinine 4362909 11 $32023975 07 $728

82607 Vitamin B-12 3334018 08 $71897559 15 $2121

82728 Assay of ferritin 4361621 11 $84963813 17 $1917

83036 Glycosylated hemoglobin test

12652264 30 $175307639 36 $1366

83540 Assay of iron 5455091 13 $49960956 10 $912

83550 Iron binding test 4297065 10 $52653538 11 $1230

83880 Natriuretic peptide 1135239 03 $54491238 11 $4777

83970 Assay of parathormone 3582472 09 $211655094 43 $5808

Healthcare Common Procedure Coding System continued on next page

23 HCPCS Level 1 numerical codes are identical to CPT codes and are used by CMS when services and procedures involve Medicare beneficiaries (eg 70405) The five character codes and descriptions included in this report are obtained from Current Procedural Terminology (CPTreg) copyright 2011 by the American Medical Association (AMA) CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures Any use of CPT outside of this report should refer to the most current version of the Current Procedural Terminology available from AMA Applicable FARSDFARS apply

Lab Tests Included in Review (Continued)

HCPCS Code

Description

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

84153 Assay of prostate-specific antigen total

3651490 09 $96028772 20 $2589

84443 Thyroid stimulating hormone

14728086 35 $353395445 72 $2364

85025 Complete blood count with automated differential white blood cell count

31930801 77 $351630565 72 $1094

85610 Prothrombin time 22020091 53 $123445269 25 $553

87086 Urine culture colony count 4610965 11 $53112711 11 $1136

Total 194946397 470 $2720669830 555 NA

Source Centers for Medicare amp Medicaid Services National Claims History Part B Carrier File 2012

APPENDIX B Comparison of Medicare-Allowed Amounts for Lab Tests With Rates of Other Insurers

Table B-1 Comparison of Medicare-Allowed Amounts for Lab Tests With State

Medicaid Program Rates

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If Medicaid

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

8622383 $85612322 5668213 $75265426 14

26667106 $308060147 13365771 $279044002 10

80061 Lipid panel 20096974 $293294006 9799707 $254514132 15

6636868 $29518138 6307849 $25392723 16

4153597 $14808195 3980171 $11481389 29

4808096 $15157960 4530759 $12590841 20

82306 Vitamin D 25 hydroxy 5308512 $218018917 5200763 $173834730 25

82570 Assay of urine creatinine

4432117 $31958084 4274416 $26437934 21

82607 Vitamin B-12 3283484 $69600580 3208218 $54998544 27

82728 Assay of ferritin 2343336 $44791773 2285840 $36235474 24

12374324 $168495108 11889154 $139534720 21

83540 Assay of iron 2573826 $22783202 2416826 $17777978 28

83550 Iron binding test 2001213 $24090743 1952675 $18554959 30

83880 Natriuretic peptide 982145 $46274487 947719 $38836439 19

83970 Assay of parathormone

1131955 $65699438 1103363 $54696192 20

3530885 $91280209 3415111 $78423161 16

Medicaid Program Rates (Continued)

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

14431323 $340218728 13470738 $278608047 22

Complete blood count with automated differential white blood cell count

29982902 $324139981 28708580 $256024097 27

85610 Prothrombin time 19778756 $109118351 18595275 $90002308 21

87086 Urine culture colony count

4622255 $52313325 4523417 $43254698 21

Total 177762057 $2355233694 145644565 $1965507794 20

Dollar amounts are rounded to the nearest $1 Source Centers for Medicare amp Medicaid Services (CMS) National Claims History Part B Carrier File 2012

Table B-2 Comparison of Medicare-Allowed Amounts for Lab Tests With

Federal Employees Health Benefits Plan 1 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 1 Lowest Rate

Percentage Medicare

Paid More Than

FEHB 1

8845138 $87510028 4014472 $79233694 10

27383560 $315644951 12603839 $285465515 11

80061 Lipid panel 20582622 $299733323 12236042 $264780532 13

6745292 $29999388 5393503 $21605942 39

4298157 $15328388 858224 $14827898 3

5058767 $15955168 3097997 $13384927 19

4599040 $33172982 4101514 $28388052 17

82607 Vitamin B-12 3348724 $70984263 3098644 $57669263 23

12652717 $172332541 11637788 $146644964 18

83540 Assay of iron 2610331 $23119240 2191250 $19978006 16

1144866 $66449427 802171 $57235817 16

3610064 $93330561 3382894 $69756354 34

14736021 $347421480 11997260 $256475682 35

30778859 $332847257 20154289 $277782489 20

4675245 $52956323 249964 $52816302 lt1

Total 182071977 $2406800929 116584937 $2045980151 18

Federal Employees Health Benefits Plan Dollar amounts are rounded to the nearest $1 Source CMS National Claims History Part B Carrier File 2012

FEHB 2 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 2 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 2

8868300 $87691704 6406107 $56925617 54

27406336 $315878919 23616591 $190298975 66

80061 Lipid panel 20620917 $300263670 17830508 $181050752 66

6803822 $30259846 5013009 $27272462 11

4312499 $15380015 801000 $14659027 5

5071508 $15995094 2423151 $15081085 6

82306 Vitamin D 25 hydroxy 5394422 $221597882 1 $221597881 lt1

4630130 $33399315 234400 $33218013 1

82607 Vitamin B-12 3354340 $71103569 2647056 $67236703 6

12678817 $172653909 10844674 $158505857 9

83540 Assay of iron 2611112 $23123274 2377920 $13725941 68

83880 Natriuretic peptide 1003642 $47301371 37291 $47200413 lt1

1140880 $66217932 1033874 $52503547 26

3616338 $93492483 3299294 $75992390 23

14761102 $348014395 13578188 $238945858 46

30827609 $333380573 22581252 $240858678 38

4703253 $53234232 4376383 $47958561 11

Total 182474941 $2410847338 130824122 $1853986362 30

Dollar amounts are rounded to the nearest $1 Source CMS National Claims History Part B Carrier File 2012

FEHB 3 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 3 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 3

8870790 $87715544 5395466 $67285713 30

27406336 $315878919 16006044 $255119055 24

80061 Lipid panel 20620917 $300263670 11088845 $250104002 20

6804619 $30263393 4301384 $25300428 20

4312499 $15380015 2843481 $13316748 15

5078609 $16012775 3061511 $13696536 17

4649643 $33541369 3644077 $25746329 30

82607 Vitamin B-12 3363543 $71298574 2999341 $50209954 42

12678817 $172653909 9693743 $133570423 29

83540 Assay of iron 2625017 $23249999 2261945 $16042910 45

1154873 $67030516 1013627 $47853311 40

3616338 $93492483 3061675 $68755732 36

14761102 $348014395 12759702 $249494146 39

30827609 $333380573 24038398 $258080023 29

4703518 $53236384 4222236 $41570728 28

Total 182683830 $2416397192 128835738 $1852995878 30

APPENDIX C Medicare Clinical Laboratory Fee Schedule State Medicaid Program Fee Schedule and Federal Employees Health Benefits Program Median Payment Rates for Selected Laboratory Test Codes

The following table contains the Medicare Clinical Laboratory Fee Schedule (CLFS) rates and the payment rates reported to us by State Medicaid programs and Federal Employees Health Benefits (FEHB) programs by Healthcare Common Procedure Coding System (HCPCS)25

and geographic area

APPENDIX C Medicare CLFS State Medicaid Program Fee Schedule and FEHB Program Median Payment Rates for Selected Laboratory Test Codes (Continued)

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

Note ldquoNArdquo indicates that no price was reported for the test continued on next page

Medicare CLFS State Medicaid Program Fee Schedule and FEHB Program Median Payment Rates for Selected Laboratory Test Codes (Continued)

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

continued on next page Four States (CA KS MO and NY) are divided into multiple Medicare carrier jurisdictions Each jurisdiction may have a different price for some HCPCS codes In jurisdictions where prices differ differences are signified using ldquordquo between each jurisdictionrsquos prices

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

continued on next page

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

Source Office of Inspector General analysis of Medicare CLFS State Medicaid Program and FEHB plan payment rates 2012

APPENDIX D Potential Savings to Medicare

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Percentage Savings to

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

Potential Savings to Medicare (Continued)

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

Dollar amounts are rounded to the nearest $1 Source Centers for Medicare amp Medicaid Services National Claims History Part B Carrier File 2012

APPENDIX E Agency Comments

Centers tor Medicare amp Medicaid Services

middot--------middotmiddotmiddotmiddot--middotmiddot--shyAdministrator Washington DC 20201

APR 2 6 2013DATE

TO Daniel R Levinson Inspector General

FROM Matilrn avenner Actilllg Administrator

SUBJECT Office M IJYpector General (DIG) Draft Report Comparison of Laboratory Test Payment Rates Medicare Could Achieve Substantial Savings (OEI-07-I 1-000 I0)

Thank you for the opportunity to review and comment on this OlG draft report 1be Centers for Medicare amp Medicaid Services (CMS) appreciates OIG s effort to examine the laboratory payment rates for different payers OIG collected payment data from 50 state Medicaid programs and three Federal Employees Health Benefits (FE B) plans that pay for laboratory tests on a fcc-for-service basis OIG requested the payment rates for 20 laboratory tests and for each test compared Medicare paid claims with the state Medicaid program fee schedule amount and FEHB plan median claim payment amounts State Medicaid programs and FEHB plans were surveyed to determine how their laboratory test fee schedules or payment rates were formulated whether a copayment was charged to the patient and whether laboratory test charges counted towards a members deductible

The OIG found that in 20 II Medicare paid between 18 and 30 percent more than other insurers for 20 high-volume andor high-expenditure laboratory tests State Medicaid programs and FEHB plans usc the Medicare clinical laboratory fee schedule as a basis for establishing their 01gtn fee schedules and payment rates although most pay Jess However unlike Medicare FEHB programs incorporate factors such as competitor information changes in technology used in perfom1ing laboratory tests and provider requests in their payment rates Some state Medicaid programs and FEHB plans required copayments for laboratory tests which in effect lowered the costs oflaboratory tests for the insurer CMSs responses to OIGs recommendations arc discussed below

OJG Recommendation I

The 010 recommends that CMS seek legislation that would allow CMS to establish lower payment rates for lab tests

CMS Response

The CMS appreciates OIGs recommendation and the valuable work reflected in this report CMS is currently exploring whether it has authority under the current statute to revise payment~ for clinical diagnostic laboratory services consistent with the OIGs recommendation

Comparing Lab Test Payment Rates Medicare Could Achieve Substantial Savings (OEI-07-11-0001 0) 47

Agency Comments (Continued)

ACKNOWLEDGMENTS This report was prepared under the direction of Brian T Whitley Acting Regional Inspector General for Evaluation and Inspections in the Kansas City regional office

Tricia Fields served as the team leader for this study Other Office of Evaluation and Inspections staff from the Kansas City regional office who conducted the study include Michael P Barrett and Teresa Dailey Other regional and central office staff who contributed include Kevin Farber Scott Horning Scott Manley Brian Pattison Debra Roush and Mandy Walz

Office of Inspector Generalhttpoighhsgov

The mission of the Office of Inspector General (OIG) as mandated by Public Law 95-452 as amended is to protect the integrity of the Department of Health and Human Services (HHS) pr ograms as well as the health and welfare of beneficiaries served by those programs This statutory mission is c arried out through a nationwide network of audits investigations and inspections conducted by the following operating components

Office of Audit Services

The Office of Audit Services (OAS) provides auditing services for HHS either by conducting audits with its own audit resources or by overseeing audit work done by others Audits examine the performance of HHS programs andor its grantees and contractors in carrying out their respective responsibilities and are intended to provide independent assessments of HHS programs and operations These assessments help reduce waste abuse and mismanagement and promote economy and efficiency throughout HHS

Office of Evaluation and Inspections

The Office of Evaluation and Inspections (OEI) conducts national evaluations to provide HHS Congress and the public with timely useful and reliable information on significant issues These evaluations focus on preventing fraud waste or abuse and promoting economy efficiency and effectiveness of departmental programs To promote impact OEI reports also present practical recommendations for improving program operations

Office of Investigations

The Office of Investigations (OI) conducts criminal civil and administrative investigations of fraud and misconduct related to HHS programs operations and beneficiaries With investigators working in all 50 States and the District of Columbia OI utilizes its resources by actively coordinating with the Department of Justice and other Federal State and local law enforcement authorities The investigative efforts of OI often lead to criminal convictions administrative sanctions andor civil monetary penalties

Office of Counsel to the Inspector General

The Office of Counsel to the Inspector General (OCIG) provides general legal services to OIG rendering adv ice and opinions on HHS programs and operations and providing all legal support for OIGrsquos i nternal operations OCIG represents OIG in all civil and administrative fraud and abuse cases involving HHS programs including False Claims Act program exclusion and civil monetary penalty cases In connection with these cases OCIG also negotiates and monitors corporate integrity agreements OCIG renders advisory opinions issues compliance program guidance publishes fraud alerts and provides other guidance to the health care industry concerning the anti-kickback statute and other OIG enforcement authorities

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

conclusion and recommendations13

agency comments and OIG response13

appendix a13

appendix b13

appendix c13

appendix d13

appendix e agency comments13

acknowledgments13

inside cover13

EXECUTIVE SUMMARY - COMPARING LAB TEST PAYMENT RATES MEDICARE COULD ACHIEVE SUBSTANTIAL SAVINGS OEI-07-11-00010

WHY WE DID THIS STUDY

Medicare is the largest payer of clinical laboratory (lab) services in the Nation It paid approximately $82 billion for lab tests in 2010 which accounted for 3 percent of all Medicare Part B payments Prior to this evaluation there had not been a comparison of Medicare payment rates to those of other health care service payers Such a comparison will help ensure that Medicare is a prudent purchaser of lab services

HOW WE DID THIS STUDY

We collected payment data from 50 State Medicaid programs and 3 Federal Employees Health Benefits (FEHB) plans that pay for lab tests on a fee-for-service basis We requested the payment rates in effect from January 1 through March 31 2011 for 20 lab tests For each lab test in each geographic area represented on the Medicare Clinical Laboratory Fee Schedule (CLFS) we compared Medicare paid claims with the State Medicaid program fee schedule amount and FEHB plan median claim payment amounts We surveyed State Medicaid programs and FEHB plans to determine how their lab test fee schedules or payment rates were formulated whether a copayment was charged to the patient and whether lab test charges counted towards a memberrsquos deductible

WHAT WE FOUND

In 2011 Medicare paid between 18 and 30 percent more than other insurers for 20 high-volume andor high-expenditure lab tests Medicare could have saved $910 million or 38 percent on these lab tests if it had paid providers at the lowest established rate in each geographic area State Medicaid programs and 83 percent of FEHB plans use the Medicare CLFS as a basis for establishing their own fee schedules and payment rates although most pay less However unlike Medicare FEHB programs incorporate factors such as competitor information changes in technology used in performing lab tests and provider requests in their payment rates Some State Medicaid programs and FEHB plans required copayments for lab tests which in effect lowered the costs of lab tests for the insurer

WHAT WE RECOMMEND

We recommend that the Centers for Medicare amp Medicaid Services (CMS) seek legislation that would allow it to establish lower payment rates for lab tests and consider seeking legislation to institute copayments and deductibles for lab tests In its comments CMS stated that it is exploring whether it has authority under current statute to revise payments for lab tests consistent with OIGrsquos recommendation and that a proposal to establish ldquodeductibles and coinsurancerdquo for lab tests is not included in the fiscal year 2014 Presidentrsquos Budget

TABLE OF CONTENTS

Objectives 1

Background1

Methodology4

Findings9

Appendixes 16

Acknowledgments48

METHODOLOGY

FEHB 1 1054 $2406800929

FEHB 2 1082 $2410847338

FEHB 3 1119 $2416397192

HCPCS Code

Insurer Payment

Lowest Available

Medicare

$1230 $1160 $1660 $1228 $751

$751 $1230 minus $751

= $479

$2500000000

$2000000000

$1500000000

$1000000000

$2355 Billion

$1966 Billion

$2407 Billion

$2046 Billion

$2411 Billion

$1854 Billion

$2416 Billion

$1853 Billion

Health Insurers

FINDINGS

Insurer

Medicare Rates

by Insurer

Medicaid 65 6 95 9 937 85 23

FEHB 1 402 38 6 1 646 61 66

FEHB 2 486 45 1 lt1 595 55 38

FEHB 3 506 45 9 1 604 54 1

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

9355762 23 $94325286 19 $1191

27232042 66 $319935253 65 $1487

80061 Lipid panel 20970947 51 $310596151 63 $1885

6709626 16 $30435748 06 $445

4416987 11 $16008487 03 $360

4805501 12 $15435365 03 $316

82607 Vitamin B-12 3334018 08 $71897559 15 $2121

12652264 30 $175307639 36 $1366

83540 Assay of iron 5455091 13 $49960956 10 $912

HCPCS Code

Description

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

3651490 09 $96028772 20 $2589

14728086 35 $353395445 72 $2364

31930801 77 $351630565 72 $1094

Total 194946397 470 $2720669830 555 NA

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

8622383 $85612322 5668213 $75265426 14

26667106 $308060147 13365771 $279044002 10

80061 Lipid panel 20096974 $293294006 9799707 $254514132 15

6636868 $29518138 6307849 $25392723 16

4153597 $14808195 3980171 $11481389 29

4808096 $15157960 4530759 $12590841 20

4432117 $31958084 4274416 $26437934 21

82607 Vitamin B-12 3283484 $69600580 3208218 $54998544 27

12374324 $168495108 11889154 $139534720 21

83540 Assay of iron 2573826 $22783202 2416826 $17777978 28

1131955 $65699438 1103363 $54696192 20

3530885 $91280209 3415111 $78423161 16

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

14431323 $340218728 13470738 $278608047 22

29982902 $324139981 28708580 $256024097 27

4622255 $52313325 4523417 $43254698 21

Total 177762057 $2355233694 145644565 $1965507794 20

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 1 Lowest Rate

Percentage Medicare

Paid More Than

FEHB 1

8845138 $87510028 4014472 $79233694 10

27383560 $315644951 12603839 $285465515 11

80061 Lipid panel 20582622 $299733323 12236042 $264780532 13

6745292 $29999388 5393503 $21605942 39

4298157 $15328388 858224 $14827898 3

5058767 $15955168 3097997 $13384927 19

4599040 $33172982 4101514 $28388052 17

82607 Vitamin B-12 3348724 $70984263 3098644 $57669263 23

12652717 $172332541 11637788 $146644964 18

83540 Assay of iron 2610331 $23119240 2191250 $19978006 16

1144866 $66449427 802171 $57235817 16

3610064 $93330561 3382894 $69756354 34

14736021 $347421480 11997260 $256475682 35

30778859 $332847257 20154289 $277782489 20

4675245 $52956323 249964 $52816302 lt1

Total 182071977 $2406800929 116584937 $2045980151 18

FEHB 2 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 2 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 2

8868300 $87691704 6406107 $56925617 54

27406336 $315878919 23616591 $190298975 66

80061 Lipid panel 20620917 $300263670 17830508 $181050752 66

6803822 $30259846 5013009 $27272462 11

4312499 $15380015 801000 $14659027 5

5071508 $15995094 2423151 $15081085 6

4630130 $33399315 234400 $33218013 1

82607 Vitamin B-12 3354340 $71103569 2647056 $67236703 6

12678817 $172653909 10844674 $158505857 9

83540 Assay of iron 2611112 $23123274 2377920 $13725941 68

1140880 $66217932 1033874 $52503547 26

3616338 $93492483 3299294 $75992390 23

14761102 $348014395 13578188 $238945858 46

30827609 $333380573 22581252 $240858678 38

4703253 $53234232 4376383 $47958561 11

Total 182474941 $2410847338 130824122 $1853986362 30

FEHB 3 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 3 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 3

8870790 $87715544 5395466 $67285713 30

27406336 $315878919 16006044 $255119055 24

80061 Lipid panel 20620917 $300263670 11088845 $250104002 20

6804619 $30263393 4301384 $25300428 20

4312499 $15380015 2843481 $13316748 15

5078609 $16012775 3061511 $13696536 17

4649643 $33541369 3644077 $25746329 30

82607 Vitamin B-12 3363543 $71298574 2999341 $50209954 42

12678817 $172653909 9693743 $133570423 29

83540 Assay of iron 2625017 $23249999 2261945 $16042910 45

1154873 $67030516 1013627 $47853311 40

3616338 $93492483 3061675 $68755732 36

14761102 $348014395 12759702 $249494146 39

30827609 $333380573 24038398 $258080023 29

4703518 $53236384 4222236 $41570728 28

Total 182683830 $2416397192 128835738 $1852995878 30

and geographic area

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

TABLE OF CONTENTS

Objectives 1

Background1

Methodology4

Findings9

Appendixes 16

Acknowledgments48

METHODOLOGY

FEHB 1 1054 $2406800929

FEHB 2 1082 $2410847338

FEHB 3 1119 $2416397192

HCPCS Code

Insurer Payment

Lowest Available

Medicare

$1230 $1160 $1660 $1228 $751

$751 $1230 minus $751

= $479

$2500000000

$2000000000

$1500000000

$1000000000

$2355 Billion

$1966 Billion

$2407 Billion

$2046 Billion

$2411 Billion

$1854 Billion

$2416 Billion

$1853 Billion

Health Insurers

FINDINGS

Insurer

Medicare Rates

by Insurer

Medicaid 65 6 95 9 937 85 23

FEHB 1 402 38 6 1 646 61 66

FEHB 2 486 45 1 lt1 595 55 38

FEHB 3 506 45 9 1 604 54 1

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

9355762 23 $94325286 19 $1191

27232042 66 $319935253 65 $1487

80061 Lipid panel 20970947 51 $310596151 63 $1885

6709626 16 $30435748 06 $445

4416987 11 $16008487 03 $360

4805501 12 $15435365 03 $316

82607 Vitamin B-12 3334018 08 $71897559 15 $2121

12652264 30 $175307639 36 $1366

83540 Assay of iron 5455091 13 $49960956 10 $912

HCPCS Code

Description

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

3651490 09 $96028772 20 $2589

14728086 35 $353395445 72 $2364

31930801 77 $351630565 72 $1094

Total 194946397 470 $2720669830 555 NA

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

8622383 $85612322 5668213 $75265426 14

26667106 $308060147 13365771 $279044002 10

80061 Lipid panel 20096974 $293294006 9799707 $254514132 15

6636868 $29518138 6307849 $25392723 16

4153597 $14808195 3980171 $11481389 29

4808096 $15157960 4530759 $12590841 20

4432117 $31958084 4274416 $26437934 21

82607 Vitamin B-12 3283484 $69600580 3208218 $54998544 27

12374324 $168495108 11889154 $139534720 21

83540 Assay of iron 2573826 $22783202 2416826 $17777978 28

1131955 $65699438 1103363 $54696192 20

3530885 $91280209 3415111 $78423161 16

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

14431323 $340218728 13470738 $278608047 22

29982902 $324139981 28708580 $256024097 27

4622255 $52313325 4523417 $43254698 21

Total 177762057 $2355233694 145644565 $1965507794 20

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 1 Lowest Rate

Percentage Medicare

Paid More Than

FEHB 1

8845138 $87510028 4014472 $79233694 10

27383560 $315644951 12603839 $285465515 11

80061 Lipid panel 20582622 $299733323 12236042 $264780532 13

6745292 $29999388 5393503 $21605942 39

4298157 $15328388 858224 $14827898 3

5058767 $15955168 3097997 $13384927 19

4599040 $33172982 4101514 $28388052 17

82607 Vitamin B-12 3348724 $70984263 3098644 $57669263 23

12652717 $172332541 11637788 $146644964 18

83540 Assay of iron 2610331 $23119240 2191250 $19978006 16

1144866 $66449427 802171 $57235817 16

3610064 $93330561 3382894 $69756354 34

14736021 $347421480 11997260 $256475682 35

30778859 $332847257 20154289 $277782489 20

4675245 $52956323 249964 $52816302 lt1

Total 182071977 $2406800929 116584937 $2045980151 18

FEHB 2 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 2 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 2

8868300 $87691704 6406107 $56925617 54

27406336 $315878919 23616591 $190298975 66

80061 Lipid panel 20620917 $300263670 17830508 $181050752 66

6803822 $30259846 5013009 $27272462 11

4312499 $15380015 801000 $14659027 5

5071508 $15995094 2423151 $15081085 6

4630130 $33399315 234400 $33218013 1

82607 Vitamin B-12 3354340 $71103569 2647056 $67236703 6

12678817 $172653909 10844674 $158505857 9

83540 Assay of iron 2611112 $23123274 2377920 $13725941 68

1140880 $66217932 1033874 $52503547 26

3616338 $93492483 3299294 $75992390 23

14761102 $348014395 13578188 $238945858 46

30827609 $333380573 22581252 $240858678 38

4703253 $53234232 4376383 $47958561 11

Total 182474941 $2410847338 130824122 $1853986362 30

FEHB 3 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 3 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 3

8870790 $87715544 5395466 $67285713 30

27406336 $315878919 16006044 $255119055 24

80061 Lipid panel 20620917 $300263670 11088845 $250104002 20

6804619 $30263393 4301384 $25300428 20

4312499 $15380015 2843481 $13316748 15

5078609 $16012775 3061511 $13696536 17

4649643 $33541369 3644077 $25746329 30

82607 Vitamin B-12 3363543 $71298574 2999341 $50209954 42

12678817 $172653909 9693743 $133570423 29

83540 Assay of iron 2625017 $23249999 2261945 $16042910 45

1154873 $67030516 1013627 $47853311 40

3616338 $93492483 3061675 $68755732 36

14761102 $348014395 12759702 $249494146 39

30827609 $333380573 24038398 $258080023 29

4703518 $53236384 4222236 $41570728 28

Total 182683830 $2416397192 128835738 $1852995878 30

and geographic area

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

METHODOLOGY

FEHB 1 1054 $2406800929

FEHB 2 1082 $2410847338

FEHB 3 1119 $2416397192

HCPCS Code

Insurer Payment

Lowest Available

Medicare

$1230 $1160 $1660 $1228 $751

$751 $1230 minus $751

= $479

$2500000000

$2000000000

$1500000000

$1000000000

$2355 Billion

$1966 Billion

$2407 Billion

$2046 Billion

$2411 Billion

$1854 Billion

$2416 Billion

$1853 Billion

Health Insurers

FINDINGS

Insurer

Medicare Rates

by Insurer

Medicaid 65 6 95 9 937 85 23

FEHB 1 402 38 6 1 646 61 66

FEHB 2 486 45 1 lt1 595 55 38

FEHB 3 506 45 9 1 604 54 1

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

9355762 23 $94325286 19 $1191

27232042 66 $319935253 65 $1487

80061 Lipid panel 20970947 51 $310596151 63 $1885

6709626 16 $30435748 06 $445

4416987 11 $16008487 03 $360

4805501 12 $15435365 03 $316

82607 Vitamin B-12 3334018 08 $71897559 15 $2121

12652264 30 $175307639 36 $1366

83540 Assay of iron 5455091 13 $49960956 10 $912

HCPCS Code

Description

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

3651490 09 $96028772 20 $2589

14728086 35 $353395445 72 $2364

31930801 77 $351630565 72 $1094

Total 194946397 470 $2720669830 555 NA

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

8622383 $85612322 5668213 $75265426 14

26667106 $308060147 13365771 $279044002 10

80061 Lipid panel 20096974 $293294006 9799707 $254514132 15

6636868 $29518138 6307849 $25392723 16

4153597 $14808195 3980171 $11481389 29

4808096 $15157960 4530759 $12590841 20

4432117 $31958084 4274416 $26437934 21

82607 Vitamin B-12 3283484 $69600580 3208218 $54998544 27

12374324 $168495108 11889154 $139534720 21

83540 Assay of iron 2573826 $22783202 2416826 $17777978 28

1131955 $65699438 1103363 $54696192 20

3530885 $91280209 3415111 $78423161 16

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

14431323 $340218728 13470738 $278608047 22

29982902 $324139981 28708580 $256024097 27

4622255 $52313325 4523417 $43254698 21

Total 177762057 $2355233694 145644565 $1965507794 20

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 1 Lowest Rate

Percentage Medicare

Paid More Than

FEHB 1

8845138 $87510028 4014472 $79233694 10

27383560 $315644951 12603839 $285465515 11

80061 Lipid panel 20582622 $299733323 12236042 $264780532 13

6745292 $29999388 5393503 $21605942 39

4298157 $15328388 858224 $14827898 3

5058767 $15955168 3097997 $13384927 19

4599040 $33172982 4101514 $28388052 17

82607 Vitamin B-12 3348724 $70984263 3098644 $57669263 23

12652717 $172332541 11637788 $146644964 18

83540 Assay of iron 2610331 $23119240 2191250 $19978006 16

1144866 $66449427 802171 $57235817 16

3610064 $93330561 3382894 $69756354 34

14736021 $347421480 11997260 $256475682 35

30778859 $332847257 20154289 $277782489 20

4675245 $52956323 249964 $52816302 lt1

Total 182071977 $2406800929 116584937 $2045980151 18

FEHB 2 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 2 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 2

8868300 $87691704 6406107 $56925617 54

27406336 $315878919 23616591 $190298975 66

80061 Lipid panel 20620917 $300263670 17830508 $181050752 66

6803822 $30259846 5013009 $27272462 11

4312499 $15380015 801000 $14659027 5

5071508 $15995094 2423151 $15081085 6

4630130 $33399315 234400 $33218013 1

82607 Vitamin B-12 3354340 $71103569 2647056 $67236703 6

12678817 $172653909 10844674 $158505857 9

83540 Assay of iron 2611112 $23123274 2377920 $13725941 68

1140880 $66217932 1033874 $52503547 26

3616338 $93492483 3299294 $75992390 23

14761102 $348014395 13578188 $238945858 46

30827609 $333380573 22581252 $240858678 38

4703253 $53234232 4376383 $47958561 11

Total 182474941 $2410847338 130824122 $1853986362 30

FEHB 3 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 3 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 3

8870790 $87715544 5395466 $67285713 30

27406336 $315878919 16006044 $255119055 24

80061 Lipid panel 20620917 $300263670 11088845 $250104002 20

6804619 $30263393 4301384 $25300428 20

4312499 $15380015 2843481 $13316748 15

5078609 $16012775 3061511 $13696536 17

4649643 $33541369 3644077 $25746329 30

82607 Vitamin B-12 3363543 $71298574 2999341 $50209954 42

12678817 $172653909 9693743 $133570423 29

83540 Assay of iron 2625017 $23249999 2261945 $16042910 45

1154873 $67030516 1013627 $47853311 40

3616338 $93492483 3061675 $68755732 36

14761102 $348014395 12759702 $249494146 39

30827609 $333380573 24038398 $258080023 29

4703518 $53236384 4222236 $41570728 28

Total 182683830 $2416397192 128835738 $1852995878 30

and geographic area

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

METHODOLOGY

FEHB 1 1054 $2406800929

FEHB 2 1082 $2410847338

FEHB 3 1119 $2416397192

HCPCS Code

Insurer Payment

Lowest Available

Medicare

$1230 $1160 $1660 $1228 $751

$751 $1230 minus $751

= $479

$2500000000

$2000000000

$1500000000

$1000000000

$2355 Billion

$1966 Billion

$2407 Billion

$2046 Billion

$2411 Billion

$1854 Billion

$2416 Billion

$1853 Billion

Health Insurers

FINDINGS

Insurer

Medicare Rates

by Insurer

Medicaid 65 6 95 9 937 85 23

FEHB 1 402 38 6 1 646 61 66

FEHB 2 486 45 1 lt1 595 55 38

FEHB 3 506 45 9 1 604 54 1

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

9355762 23 $94325286 19 $1191

27232042 66 $319935253 65 $1487

80061 Lipid panel 20970947 51 $310596151 63 $1885

6709626 16 $30435748 06 $445

4416987 11 $16008487 03 $360

4805501 12 $15435365 03 $316

82607 Vitamin B-12 3334018 08 $71897559 15 $2121

12652264 30 $175307639 36 $1366

83540 Assay of iron 5455091 13 $49960956 10 $912

HCPCS Code

Description

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

3651490 09 $96028772 20 $2589

14728086 35 $353395445 72 $2364

31930801 77 $351630565 72 $1094

Total 194946397 470 $2720669830 555 NA

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

8622383 $85612322 5668213 $75265426 14

26667106 $308060147 13365771 $279044002 10

80061 Lipid panel 20096974 $293294006 9799707 $254514132 15

6636868 $29518138 6307849 $25392723 16

4153597 $14808195 3980171 $11481389 29

4808096 $15157960 4530759 $12590841 20

4432117 $31958084 4274416 $26437934 21

82607 Vitamin B-12 3283484 $69600580 3208218 $54998544 27

12374324 $168495108 11889154 $139534720 21

83540 Assay of iron 2573826 $22783202 2416826 $17777978 28

1131955 $65699438 1103363 $54696192 20

3530885 $91280209 3415111 $78423161 16

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

14431323 $340218728 13470738 $278608047 22

29982902 $324139981 28708580 $256024097 27

4622255 $52313325 4523417 $43254698 21

Total 177762057 $2355233694 145644565 $1965507794 20

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 1 Lowest Rate

Percentage Medicare

Paid More Than

FEHB 1

8845138 $87510028 4014472 $79233694 10

27383560 $315644951 12603839 $285465515 11

80061 Lipid panel 20582622 $299733323 12236042 $264780532 13

6745292 $29999388 5393503 $21605942 39

4298157 $15328388 858224 $14827898 3

5058767 $15955168 3097997 $13384927 19

4599040 $33172982 4101514 $28388052 17

82607 Vitamin B-12 3348724 $70984263 3098644 $57669263 23

12652717 $172332541 11637788 $146644964 18

83540 Assay of iron 2610331 $23119240 2191250 $19978006 16

1144866 $66449427 802171 $57235817 16

3610064 $93330561 3382894 $69756354 34

14736021 $347421480 11997260 $256475682 35

30778859 $332847257 20154289 $277782489 20

4675245 $52956323 249964 $52816302 lt1

Total 182071977 $2406800929 116584937 $2045980151 18

FEHB 2 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 2 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 2

8868300 $87691704 6406107 $56925617 54

27406336 $315878919 23616591 $190298975 66

80061 Lipid panel 20620917 $300263670 17830508 $181050752 66

6803822 $30259846 5013009 $27272462 11

4312499 $15380015 801000 $14659027 5

5071508 $15995094 2423151 $15081085 6

4630130 $33399315 234400 $33218013 1

82607 Vitamin B-12 3354340 $71103569 2647056 $67236703 6

12678817 $172653909 10844674 $158505857 9

83540 Assay of iron 2611112 $23123274 2377920 $13725941 68

1140880 $66217932 1033874 $52503547 26

3616338 $93492483 3299294 $75992390 23

14761102 $348014395 13578188 $238945858 46

30827609 $333380573 22581252 $240858678 38

4703253 $53234232 4376383 $47958561 11

Total 182474941 $2410847338 130824122 $1853986362 30

FEHB 3 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 3 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 3

8870790 $87715544 5395466 $67285713 30

27406336 $315878919 16006044 $255119055 24

80061 Lipid panel 20620917 $300263670 11088845 $250104002 20

6804619 $30263393 4301384 $25300428 20

4312499 $15380015 2843481 $13316748 15

5078609 $16012775 3061511 $13696536 17

4649643 $33541369 3644077 $25746329 30

82607 Vitamin B-12 3363543 $71298574 2999341 $50209954 42

12678817 $172653909 9693743 $133570423 29

83540 Assay of iron 2625017 $23249999 2261945 $16042910 45

1154873 $67030516 1013627 $47853311 40

3616338 $93492483 3061675 $68755732 36

14761102 $348014395 12759702 $249494146 39

30827609 $333380573 24038398 $258080023 29

4703518 $53236384 4222236 $41570728 28

Total 182683830 $2416397192 128835738 $1852995878 30

and geographic area

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

METHODOLOGY

FEHB 1 1054 $2406800929

FEHB 2 1082 $2410847338

FEHB 3 1119 $2416397192

HCPCS Code

Insurer Payment

Lowest Available

Medicare

$1230 $1160 $1660 $1228 $751

$751 $1230 minus $751

= $479

$2500000000

$2000000000

$1500000000

$1000000000

$2355 Billion

$1966 Billion

$2407 Billion

$2046 Billion

$2411 Billion

$1854 Billion

$2416 Billion

$1853 Billion

Health Insurers

FINDINGS

Insurer

Medicare Rates

by Insurer

Medicaid 65 6 95 9 937 85 23

FEHB 1 402 38 6 1 646 61 66

FEHB 2 486 45 1 lt1 595 55 38

FEHB 3 506 45 9 1 604 54 1

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

9355762 23 $94325286 19 $1191

27232042 66 $319935253 65 $1487

80061 Lipid panel 20970947 51 $310596151 63 $1885

6709626 16 $30435748 06 $445

4416987 11 $16008487 03 $360

4805501 12 $15435365 03 $316

82607 Vitamin B-12 3334018 08 $71897559 15 $2121

12652264 30 $175307639 36 $1366

83540 Assay of iron 5455091 13 $49960956 10 $912

HCPCS Code

Description

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

3651490 09 $96028772 20 $2589

14728086 35 $353395445 72 $2364

31930801 77 $351630565 72 $1094

Total 194946397 470 $2720669830 555 NA

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

8622383 $85612322 5668213 $75265426 14

26667106 $308060147 13365771 $279044002 10

80061 Lipid panel 20096974 $293294006 9799707 $254514132 15

6636868 $29518138 6307849 $25392723 16

4153597 $14808195 3980171 $11481389 29

4808096 $15157960 4530759 $12590841 20

4432117 $31958084 4274416 $26437934 21

82607 Vitamin B-12 3283484 $69600580 3208218 $54998544 27

12374324 $168495108 11889154 $139534720 21

83540 Assay of iron 2573826 $22783202 2416826 $17777978 28

1131955 $65699438 1103363 $54696192 20

3530885 $91280209 3415111 $78423161 16

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

14431323 $340218728 13470738 $278608047 22

29982902 $324139981 28708580 $256024097 27

4622255 $52313325 4523417 $43254698 21

Total 177762057 $2355233694 145644565 $1965507794 20

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 1 Lowest Rate

Percentage Medicare

Paid More Than

FEHB 1

8845138 $87510028 4014472 $79233694 10

27383560 $315644951 12603839 $285465515 11

80061 Lipid panel 20582622 $299733323 12236042 $264780532 13

6745292 $29999388 5393503 $21605942 39

4298157 $15328388 858224 $14827898 3

5058767 $15955168 3097997 $13384927 19

4599040 $33172982 4101514 $28388052 17

82607 Vitamin B-12 3348724 $70984263 3098644 $57669263 23

12652717 $172332541 11637788 $146644964 18

83540 Assay of iron 2610331 $23119240 2191250 $19978006 16

1144866 $66449427 802171 $57235817 16

3610064 $93330561 3382894 $69756354 34

14736021 $347421480 11997260 $256475682 35

30778859 $332847257 20154289 $277782489 20

4675245 $52956323 249964 $52816302 lt1

Total 182071977 $2406800929 116584937 $2045980151 18

FEHB 2 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 2 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 2

8868300 $87691704 6406107 $56925617 54

27406336 $315878919 23616591 $190298975 66

80061 Lipid panel 20620917 $300263670 17830508 $181050752 66

6803822 $30259846 5013009 $27272462 11

4312499 $15380015 801000 $14659027 5

5071508 $15995094 2423151 $15081085 6

4630130 $33399315 234400 $33218013 1

82607 Vitamin B-12 3354340 $71103569 2647056 $67236703 6

12678817 $172653909 10844674 $158505857 9

83540 Assay of iron 2611112 $23123274 2377920 $13725941 68

1140880 $66217932 1033874 $52503547 26

3616338 $93492483 3299294 $75992390 23

14761102 $348014395 13578188 $238945858 46

30827609 $333380573 22581252 $240858678 38

4703253 $53234232 4376383 $47958561 11

Total 182474941 $2410847338 130824122 $1853986362 30

FEHB 3 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 3 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 3

8870790 $87715544 5395466 $67285713 30

27406336 $315878919 16006044 $255119055 24

80061 Lipid panel 20620917 $300263670 11088845 $250104002 20

6804619 $30263393 4301384 $25300428 20

4312499 $15380015 2843481 $13316748 15

5078609 $16012775 3061511 $13696536 17

4649643 $33541369 3644077 $25746329 30

82607 Vitamin B-12 3363543 $71298574 2999341 $50209954 42

12678817 $172653909 9693743 $133570423 29

83540 Assay of iron 2625017 $23249999 2261945 $16042910 45

1154873 $67030516 1013627 $47853311 40

3616338 $93492483 3061675 $68755732 36

14761102 $348014395 12759702 $249494146 39

30827609 $333380573 24038398 $258080023 29

4703518 $53236384 4222236 $41570728 28

Total 182683830 $2416397192 128835738 $1852995878 30

and geographic area

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

METHODOLOGY

FEHB 1 1054 $2406800929

FEHB 2 1082 $2410847338

FEHB 3 1119 $2416397192

HCPCS Code

Insurer Payment

Lowest Available

Medicare

$1230 $1160 $1660 $1228 $751

$751 $1230 minus $751

= $479

$2500000000

$2000000000

$1500000000

$1000000000

$2355 Billion

$1966 Billion

$2407 Billion

$2046 Billion

$2411 Billion

$1854 Billion

$2416 Billion

$1853 Billion

Health Insurers

FINDINGS

Insurer

Medicare Rates

by Insurer

Medicaid 65 6 95 9 937 85 23

FEHB 1 402 38 6 1 646 61 66

FEHB 2 486 45 1 lt1 595 55 38

FEHB 3 506 45 9 1 604 54 1

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

9355762 23 $94325286 19 $1191

27232042 66 $319935253 65 $1487

80061 Lipid panel 20970947 51 $310596151 63 $1885

6709626 16 $30435748 06 $445

4416987 11 $16008487 03 $360

4805501 12 $15435365 03 $316

82607 Vitamin B-12 3334018 08 $71897559 15 $2121

12652264 30 $175307639 36 $1366

83540 Assay of iron 5455091 13 $49960956 10 $912

HCPCS Code

Description

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

3651490 09 $96028772 20 $2589

14728086 35 $353395445 72 $2364

31930801 77 $351630565 72 $1094

Total 194946397 470 $2720669830 555 NA

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

8622383 $85612322 5668213 $75265426 14

26667106 $308060147 13365771 $279044002 10

80061 Lipid panel 20096974 $293294006 9799707 $254514132 15

6636868 $29518138 6307849 $25392723 16

4153597 $14808195 3980171 $11481389 29

4808096 $15157960 4530759 $12590841 20

4432117 $31958084 4274416 $26437934 21

82607 Vitamin B-12 3283484 $69600580 3208218 $54998544 27

12374324 $168495108 11889154 $139534720 21

83540 Assay of iron 2573826 $22783202 2416826 $17777978 28

1131955 $65699438 1103363 $54696192 20

3530885 $91280209 3415111 $78423161 16

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

14431323 $340218728 13470738 $278608047 22

29982902 $324139981 28708580 $256024097 27

4622255 $52313325 4523417 $43254698 21

Total 177762057 $2355233694 145644565 $1965507794 20

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 1 Lowest Rate

Percentage Medicare

Paid More Than

FEHB 1

8845138 $87510028 4014472 $79233694 10

27383560 $315644951 12603839 $285465515 11

80061 Lipid panel 20582622 $299733323 12236042 $264780532 13

6745292 $29999388 5393503 $21605942 39

4298157 $15328388 858224 $14827898 3

5058767 $15955168 3097997 $13384927 19

4599040 $33172982 4101514 $28388052 17

82607 Vitamin B-12 3348724 $70984263 3098644 $57669263 23

12652717 $172332541 11637788 $146644964 18

83540 Assay of iron 2610331 $23119240 2191250 $19978006 16

1144866 $66449427 802171 $57235817 16

3610064 $93330561 3382894 $69756354 34

14736021 $347421480 11997260 $256475682 35

30778859 $332847257 20154289 $277782489 20

4675245 $52956323 249964 $52816302 lt1

Total 182071977 $2406800929 116584937 $2045980151 18

FEHB 2 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 2 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 2

8868300 $87691704 6406107 $56925617 54

27406336 $315878919 23616591 $190298975 66

80061 Lipid panel 20620917 $300263670 17830508 $181050752 66

6803822 $30259846 5013009 $27272462 11

4312499 $15380015 801000 $14659027 5

5071508 $15995094 2423151 $15081085 6

4630130 $33399315 234400 $33218013 1

82607 Vitamin B-12 3354340 $71103569 2647056 $67236703 6

12678817 $172653909 10844674 $158505857 9

83540 Assay of iron 2611112 $23123274 2377920 $13725941 68

1140880 $66217932 1033874 $52503547 26

3616338 $93492483 3299294 $75992390 23

14761102 $348014395 13578188 $238945858 46

30827609 $333380573 22581252 $240858678 38

4703253 $53234232 4376383 $47958561 11

Total 182474941 $2410847338 130824122 $1853986362 30

FEHB 3 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 3 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 3

8870790 $87715544 5395466 $67285713 30

27406336 $315878919 16006044 $255119055 24

80061 Lipid panel 20620917 $300263670 11088845 $250104002 20

6804619 $30263393 4301384 $25300428 20

4312499 $15380015 2843481 $13316748 15

5078609 $16012775 3061511 $13696536 17

4649643 $33541369 3644077 $25746329 30

82607 Vitamin B-12 3363543 $71298574 2999341 $50209954 42

12678817 $172653909 9693743 $133570423 29

83540 Assay of iron 2625017 $23249999 2261945 $16042910 45

1154873 $67030516 1013627 $47853311 40

3616338 $93492483 3061675 $68755732 36

14761102 $348014395 12759702 $249494146 39

30827609 $333380573 24038398 $258080023 29

4703518 $53236384 4222236 $41570728 28

Total 182683830 $2416397192 128835738 $1852995878 30

and geographic area

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

FEHB 1 1054 $2406800929

FEHB 2 1082 $2410847338

FEHB 3 1119 $2416397192

HCPCS Code

Insurer Payment

Lowest Available

Medicare

$1230 $1160 $1660 $1228 $751

$751 $1230 minus $751

= $479

$2500000000

$2000000000

$1500000000

$1000000000

$2355 Billion

$1966 Billion

$2407 Billion

$2046 Billion

$2411 Billion

$1854 Billion

$2416 Billion

$1853 Billion

Health Insurers

FINDINGS

Insurer

Medicare Rates

by Insurer

Medicaid 65 6 95 9 937 85 23

FEHB 1 402 38 6 1 646 61 66

FEHB 2 486 45 1 lt1 595 55 38

FEHB 3 506 45 9 1 604 54 1

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

9355762 23 $94325286 19 $1191

27232042 66 $319935253 65 $1487

80061 Lipid panel 20970947 51 $310596151 63 $1885

6709626 16 $30435748 06 $445

4416987 11 $16008487 03 $360

4805501 12 $15435365 03 $316

82607 Vitamin B-12 3334018 08 $71897559 15 $2121

12652264 30 $175307639 36 $1366

83540 Assay of iron 5455091 13 $49960956 10 $912

HCPCS Code

Description

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

3651490 09 $96028772 20 $2589

14728086 35 $353395445 72 $2364

31930801 77 $351630565 72 $1094

Total 194946397 470 $2720669830 555 NA

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

8622383 $85612322 5668213 $75265426 14

26667106 $308060147 13365771 $279044002 10

80061 Lipid panel 20096974 $293294006 9799707 $254514132 15

6636868 $29518138 6307849 $25392723 16

4153597 $14808195 3980171 $11481389 29

4808096 $15157960 4530759 $12590841 20

4432117 $31958084 4274416 $26437934 21

82607 Vitamin B-12 3283484 $69600580 3208218 $54998544 27

12374324 $168495108 11889154 $139534720 21

83540 Assay of iron 2573826 $22783202 2416826 $17777978 28

1131955 $65699438 1103363 $54696192 20

3530885 $91280209 3415111 $78423161 16

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

14431323 $340218728 13470738 $278608047 22

29982902 $324139981 28708580 $256024097 27

4622255 $52313325 4523417 $43254698 21

Total 177762057 $2355233694 145644565 $1965507794 20

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 1 Lowest Rate

Percentage Medicare

Paid More Than

FEHB 1

8845138 $87510028 4014472 $79233694 10

27383560 $315644951 12603839 $285465515 11

80061 Lipid panel 20582622 $299733323 12236042 $264780532 13

6745292 $29999388 5393503 $21605942 39

4298157 $15328388 858224 $14827898 3

5058767 $15955168 3097997 $13384927 19

4599040 $33172982 4101514 $28388052 17

82607 Vitamin B-12 3348724 $70984263 3098644 $57669263 23

12652717 $172332541 11637788 $146644964 18

83540 Assay of iron 2610331 $23119240 2191250 $19978006 16

1144866 $66449427 802171 $57235817 16

3610064 $93330561 3382894 $69756354 34

14736021 $347421480 11997260 $256475682 35

30778859 $332847257 20154289 $277782489 20

4675245 $52956323 249964 $52816302 lt1

Total 182071977 $2406800929 116584937 $2045980151 18

FEHB 2 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 2 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 2

8868300 $87691704 6406107 $56925617 54

27406336 $315878919 23616591 $190298975 66

80061 Lipid panel 20620917 $300263670 17830508 $181050752 66

6803822 $30259846 5013009 $27272462 11

4312499 $15380015 801000 $14659027 5

5071508 $15995094 2423151 $15081085 6

4630130 $33399315 234400 $33218013 1

82607 Vitamin B-12 3354340 $71103569 2647056 $67236703 6

12678817 $172653909 10844674 $158505857 9

83540 Assay of iron 2611112 $23123274 2377920 $13725941 68

1140880 $66217932 1033874 $52503547 26

3616338 $93492483 3299294 $75992390 23

14761102 $348014395 13578188 $238945858 46

30827609 $333380573 22581252 $240858678 38

4703253 $53234232 4376383 $47958561 11

Total 182474941 $2410847338 130824122 $1853986362 30

FEHB 3 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 3 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 3

8870790 $87715544 5395466 $67285713 30

27406336 $315878919 16006044 $255119055 24

80061 Lipid panel 20620917 $300263670 11088845 $250104002 20

6804619 $30263393 4301384 $25300428 20

4312499 $15380015 2843481 $13316748 15

5078609 $16012775 3061511 $13696536 17

4649643 $33541369 3644077 $25746329 30

82607 Vitamin B-12 3363543 $71298574 2999341 $50209954 42

12678817 $172653909 9693743 $133570423 29

83540 Assay of iron 2625017 $23249999 2261945 $16042910 45

1154873 $67030516 1013627 $47853311 40

3616338 $93492483 3061675 $68755732 36

14761102 $348014395 12759702 $249494146 39

30827609 $333380573 24038398 $258080023 29

4703518 $53236384 4222236 $41570728 28

Total 182683830 $2416397192 128835738 $1852995878 30

and geographic area

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

FEHB 1 1054 $2406800929

FEHB 2 1082 $2410847338

FEHB 3 1119 $2416397192

HCPCS Code

Insurer Payment

Lowest Available

Medicare

$1230 $1160 $1660 $1228 $751

$751 $1230 minus $751

= $479

$2500000000

$2000000000

$1500000000

$1000000000

$2355 Billion

$1966 Billion

$2407 Billion

$2046 Billion

$2411 Billion

$1854 Billion

$2416 Billion

$1853 Billion

Health Insurers

FINDINGS

Insurer

Medicare Rates

by Insurer

Medicaid 65 6 95 9 937 85 23

FEHB 1 402 38 6 1 646 61 66

FEHB 2 486 45 1 lt1 595 55 38

FEHB 3 506 45 9 1 604 54 1

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

9355762 23 $94325286 19 $1191

27232042 66 $319935253 65 $1487

80061 Lipid panel 20970947 51 $310596151 63 $1885

6709626 16 $30435748 06 $445

4416987 11 $16008487 03 $360

4805501 12 $15435365 03 $316

82607 Vitamin B-12 3334018 08 $71897559 15 $2121

12652264 30 $175307639 36 $1366

83540 Assay of iron 5455091 13 $49960956 10 $912

HCPCS Code

Description

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

3651490 09 $96028772 20 $2589

14728086 35 $353395445 72 $2364

31930801 77 $351630565 72 $1094

Total 194946397 470 $2720669830 555 NA

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

8622383 $85612322 5668213 $75265426 14

26667106 $308060147 13365771 $279044002 10

80061 Lipid panel 20096974 $293294006 9799707 $254514132 15

6636868 $29518138 6307849 $25392723 16

4153597 $14808195 3980171 $11481389 29

4808096 $15157960 4530759 $12590841 20

4432117 $31958084 4274416 $26437934 21

82607 Vitamin B-12 3283484 $69600580 3208218 $54998544 27

12374324 $168495108 11889154 $139534720 21

83540 Assay of iron 2573826 $22783202 2416826 $17777978 28

1131955 $65699438 1103363 $54696192 20

3530885 $91280209 3415111 $78423161 16

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

14431323 $340218728 13470738 $278608047 22

29982902 $324139981 28708580 $256024097 27

4622255 $52313325 4523417 $43254698 21

Total 177762057 $2355233694 145644565 $1965507794 20

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 1 Lowest Rate

Percentage Medicare

Paid More Than

FEHB 1

8845138 $87510028 4014472 $79233694 10

27383560 $315644951 12603839 $285465515 11

80061 Lipid panel 20582622 $299733323 12236042 $264780532 13

6745292 $29999388 5393503 $21605942 39

4298157 $15328388 858224 $14827898 3

5058767 $15955168 3097997 $13384927 19

4599040 $33172982 4101514 $28388052 17

82607 Vitamin B-12 3348724 $70984263 3098644 $57669263 23

12652717 $172332541 11637788 $146644964 18

83540 Assay of iron 2610331 $23119240 2191250 $19978006 16

1144866 $66449427 802171 $57235817 16

3610064 $93330561 3382894 $69756354 34

14736021 $347421480 11997260 $256475682 35

30778859 $332847257 20154289 $277782489 20

4675245 $52956323 249964 $52816302 lt1

Total 182071977 $2406800929 116584937 $2045980151 18

FEHB 2 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 2 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 2

8868300 $87691704 6406107 $56925617 54

27406336 $315878919 23616591 $190298975 66

80061 Lipid panel 20620917 $300263670 17830508 $181050752 66

6803822 $30259846 5013009 $27272462 11

4312499 $15380015 801000 $14659027 5

5071508 $15995094 2423151 $15081085 6

4630130 $33399315 234400 $33218013 1

82607 Vitamin B-12 3354340 $71103569 2647056 $67236703 6

12678817 $172653909 10844674 $158505857 9

83540 Assay of iron 2611112 $23123274 2377920 $13725941 68

1140880 $66217932 1033874 $52503547 26

3616338 $93492483 3299294 $75992390 23

14761102 $348014395 13578188 $238945858 46

30827609 $333380573 22581252 $240858678 38

4703253 $53234232 4376383 $47958561 11

Total 182474941 $2410847338 130824122 $1853986362 30

FEHB 3 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 3 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 3

8870790 $87715544 5395466 $67285713 30

27406336 $315878919 16006044 $255119055 24

80061 Lipid panel 20620917 $300263670 11088845 $250104002 20

6804619 $30263393 4301384 $25300428 20

4312499 $15380015 2843481 $13316748 15

5078609 $16012775 3061511 $13696536 17

4649643 $33541369 3644077 $25746329 30

82607 Vitamin B-12 3363543 $71298574 2999341 $50209954 42

12678817 $172653909 9693743 $133570423 29

83540 Assay of iron 2625017 $23249999 2261945 $16042910 45

1154873 $67030516 1013627 $47853311 40

3616338 $93492483 3061675 $68755732 36

14761102 $348014395 12759702 $249494146 39

30827609 $333380573 24038398 $258080023 29

4703518 $53236384 4222236 $41570728 28

Total 182683830 $2416397192 128835738 $1852995878 30

and geographic area

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

FEHB 1 1054 $2406800929

FEHB 2 1082 $2410847338

FEHB 3 1119 $2416397192

HCPCS Code

Insurer Payment

Lowest Available

Medicare

$1230 $1160 $1660 $1228 $751

$751 $1230 minus $751

= $479

$2500000000

$2000000000

$1500000000

$1000000000

$2355 Billion

$1966 Billion

$2407 Billion

$2046 Billion

$2411 Billion

$1854 Billion

$2416 Billion

$1853 Billion

Health Insurers

FINDINGS

Insurer

Medicare Rates

by Insurer

Medicaid 65 6 95 9 937 85 23

FEHB 1 402 38 6 1 646 61 66

FEHB 2 486 45 1 lt1 595 55 38

FEHB 3 506 45 9 1 604 54 1

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

9355762 23 $94325286 19 $1191

27232042 66 $319935253 65 $1487

80061 Lipid panel 20970947 51 $310596151 63 $1885

6709626 16 $30435748 06 $445

4416987 11 $16008487 03 $360

4805501 12 $15435365 03 $316

82607 Vitamin B-12 3334018 08 $71897559 15 $2121

12652264 30 $175307639 36 $1366

83540 Assay of iron 5455091 13 $49960956 10 $912

HCPCS Code

Description

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

3651490 09 $96028772 20 $2589

14728086 35 $353395445 72 $2364

31930801 77 $351630565 72 $1094

Total 194946397 470 $2720669830 555 NA

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

8622383 $85612322 5668213 $75265426 14

26667106 $308060147 13365771 $279044002 10

80061 Lipid panel 20096974 $293294006 9799707 $254514132 15

6636868 $29518138 6307849 $25392723 16

4153597 $14808195 3980171 $11481389 29

4808096 $15157960 4530759 $12590841 20

4432117 $31958084 4274416 $26437934 21

82607 Vitamin B-12 3283484 $69600580 3208218 $54998544 27

12374324 $168495108 11889154 $139534720 21

83540 Assay of iron 2573826 $22783202 2416826 $17777978 28

1131955 $65699438 1103363 $54696192 20

3530885 $91280209 3415111 $78423161 16

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

14431323 $340218728 13470738 $278608047 22

29982902 $324139981 28708580 $256024097 27

4622255 $52313325 4523417 $43254698 21

Total 177762057 $2355233694 145644565 $1965507794 20

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 1 Lowest Rate

Percentage Medicare

Paid More Than

FEHB 1

8845138 $87510028 4014472 $79233694 10

27383560 $315644951 12603839 $285465515 11

80061 Lipid panel 20582622 $299733323 12236042 $264780532 13

6745292 $29999388 5393503 $21605942 39

4298157 $15328388 858224 $14827898 3

5058767 $15955168 3097997 $13384927 19

4599040 $33172982 4101514 $28388052 17

82607 Vitamin B-12 3348724 $70984263 3098644 $57669263 23

12652717 $172332541 11637788 $146644964 18

83540 Assay of iron 2610331 $23119240 2191250 $19978006 16

1144866 $66449427 802171 $57235817 16

3610064 $93330561 3382894 $69756354 34

14736021 $347421480 11997260 $256475682 35

30778859 $332847257 20154289 $277782489 20

4675245 $52956323 249964 $52816302 lt1

Total 182071977 $2406800929 116584937 $2045980151 18

FEHB 2 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 2 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 2

8868300 $87691704 6406107 $56925617 54

27406336 $315878919 23616591 $190298975 66

80061 Lipid panel 20620917 $300263670 17830508 $181050752 66

6803822 $30259846 5013009 $27272462 11

4312499 $15380015 801000 $14659027 5

5071508 $15995094 2423151 $15081085 6

4630130 $33399315 234400 $33218013 1

82607 Vitamin B-12 3354340 $71103569 2647056 $67236703 6

12678817 $172653909 10844674 $158505857 9

83540 Assay of iron 2611112 $23123274 2377920 $13725941 68

1140880 $66217932 1033874 $52503547 26

3616338 $93492483 3299294 $75992390 23

14761102 $348014395 13578188 $238945858 46

30827609 $333380573 22581252 $240858678 38

4703253 $53234232 4376383 $47958561 11

Total 182474941 $2410847338 130824122 $1853986362 30

FEHB 3 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 3 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 3

8870790 $87715544 5395466 $67285713 30

27406336 $315878919 16006044 $255119055 24

80061 Lipid panel 20620917 $300263670 11088845 $250104002 20

6804619 $30263393 4301384 $25300428 20

4312499 $15380015 2843481 $13316748 15

5078609 $16012775 3061511 $13696536 17

4649643 $33541369 3644077 $25746329 30

82607 Vitamin B-12 3363543 $71298574 2999341 $50209954 42

12678817 $172653909 9693743 $133570423 29

83540 Assay of iron 2625017 $23249999 2261945 $16042910 45

1154873 $67030516 1013627 $47853311 40

3616338 $93492483 3061675 $68755732 36

14761102 $348014395 12759702 $249494146 39

30827609 $333380573 24038398 $258080023 29

4703518 $53236384 4222236 $41570728 28

Total 182683830 $2416397192 128835738 $1852995878 30

and geographic area

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

$2500000000

$2000000000

$1500000000

$1000000000

$2355 Billion

$1966 Billion

$2407 Billion

$2046 Billion

$2411 Billion

$1854 Billion

$2416 Billion

$1853 Billion

Health Insurers

FINDINGS

Insurer

Medicare Rates

by Insurer

Medicaid 65 6 95 9 937 85 23

FEHB 1 402 38 6 1 646 61 66

FEHB 2 486 45 1 lt1 595 55 38

FEHB 3 506 45 9 1 604 54 1

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

9355762 23 $94325286 19 $1191

27232042 66 $319935253 65 $1487

80061 Lipid panel 20970947 51 $310596151 63 $1885

6709626 16 $30435748 06 $445

4416987 11 $16008487 03 $360

4805501 12 $15435365 03 $316

82607 Vitamin B-12 3334018 08 $71897559 15 $2121

12652264 30 $175307639 36 $1366

83540 Assay of iron 5455091 13 $49960956 10 $912

HCPCS Code

Description

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

3651490 09 $96028772 20 $2589

14728086 35 $353395445 72 $2364

31930801 77 $351630565 72 $1094

Total 194946397 470 $2720669830 555 NA

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

8622383 $85612322 5668213 $75265426 14

26667106 $308060147 13365771 $279044002 10

80061 Lipid panel 20096974 $293294006 9799707 $254514132 15

6636868 $29518138 6307849 $25392723 16

4153597 $14808195 3980171 $11481389 29

4808096 $15157960 4530759 $12590841 20

4432117 $31958084 4274416 $26437934 21

82607 Vitamin B-12 3283484 $69600580 3208218 $54998544 27

12374324 $168495108 11889154 $139534720 21

83540 Assay of iron 2573826 $22783202 2416826 $17777978 28

1131955 $65699438 1103363 $54696192 20

3530885 $91280209 3415111 $78423161 16

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

14431323 $340218728 13470738 $278608047 22

29982902 $324139981 28708580 $256024097 27

4622255 $52313325 4523417 $43254698 21

Total 177762057 $2355233694 145644565 $1965507794 20

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 1 Lowest Rate

Percentage Medicare

Paid More Than

FEHB 1

8845138 $87510028 4014472 $79233694 10

27383560 $315644951 12603839 $285465515 11

80061 Lipid panel 20582622 $299733323 12236042 $264780532 13

6745292 $29999388 5393503 $21605942 39

4298157 $15328388 858224 $14827898 3

5058767 $15955168 3097997 $13384927 19

4599040 $33172982 4101514 $28388052 17

82607 Vitamin B-12 3348724 $70984263 3098644 $57669263 23

12652717 $172332541 11637788 $146644964 18

83540 Assay of iron 2610331 $23119240 2191250 $19978006 16

1144866 $66449427 802171 $57235817 16

3610064 $93330561 3382894 $69756354 34

14736021 $347421480 11997260 $256475682 35

30778859 $332847257 20154289 $277782489 20

4675245 $52956323 249964 $52816302 lt1

Total 182071977 $2406800929 116584937 $2045980151 18

FEHB 2 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 2 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 2

8868300 $87691704 6406107 $56925617 54

27406336 $315878919 23616591 $190298975 66

80061 Lipid panel 20620917 $300263670 17830508 $181050752 66

6803822 $30259846 5013009 $27272462 11

4312499 $15380015 801000 $14659027 5

5071508 $15995094 2423151 $15081085 6

4630130 $33399315 234400 $33218013 1

82607 Vitamin B-12 3354340 $71103569 2647056 $67236703 6

12678817 $172653909 10844674 $158505857 9

83540 Assay of iron 2611112 $23123274 2377920 $13725941 68

1140880 $66217932 1033874 $52503547 26

3616338 $93492483 3299294 $75992390 23

14761102 $348014395 13578188 $238945858 46

30827609 $333380573 22581252 $240858678 38

4703253 $53234232 4376383 $47958561 11

Total 182474941 $2410847338 130824122 $1853986362 30

FEHB 3 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 3 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 3

8870790 $87715544 5395466 $67285713 30

27406336 $315878919 16006044 $255119055 24

80061 Lipid panel 20620917 $300263670 11088845 $250104002 20

6804619 $30263393 4301384 $25300428 20

4312499 $15380015 2843481 $13316748 15

5078609 $16012775 3061511 $13696536 17

4649643 $33541369 3644077 $25746329 30

82607 Vitamin B-12 3363543 $71298574 2999341 $50209954 42

12678817 $172653909 9693743 $133570423 29

83540 Assay of iron 2625017 $23249999 2261945 $16042910 45

1154873 $67030516 1013627 $47853311 40

3616338 $93492483 3061675 $68755732 36

14761102 $348014395 12759702 $249494146 39

30827609 $333380573 24038398 $258080023 29

4703518 $53236384 4222236 $41570728 28

Total 182683830 $2416397192 128835738 $1852995878 30

and geographic area

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

$2500000000

$2000000000

$1500000000

$1000000000

$2355 Billion

$1966 Billion

$2407 Billion

$2046 Billion

$2411 Billion

$1854 Billion

$2416 Billion

$1853 Billion

Health Insurers

FINDINGS

Insurer

Medicare Rates

by Insurer

Medicaid 65 6 95 9 937 85 23

FEHB 1 402 38 6 1 646 61 66

FEHB 2 486 45 1 lt1 595 55 38

FEHB 3 506 45 9 1 604 54 1

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

9355762 23 $94325286 19 $1191

27232042 66 $319935253 65 $1487

80061 Lipid panel 20970947 51 $310596151 63 $1885

6709626 16 $30435748 06 $445

4416987 11 $16008487 03 $360

4805501 12 $15435365 03 $316

82607 Vitamin B-12 3334018 08 $71897559 15 $2121

12652264 30 $175307639 36 $1366

83540 Assay of iron 5455091 13 $49960956 10 $912

HCPCS Code

Description

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

3651490 09 $96028772 20 $2589

14728086 35 $353395445 72 $2364

31930801 77 $351630565 72 $1094

Total 194946397 470 $2720669830 555 NA

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

8622383 $85612322 5668213 $75265426 14

26667106 $308060147 13365771 $279044002 10

80061 Lipid panel 20096974 $293294006 9799707 $254514132 15

6636868 $29518138 6307849 $25392723 16

4153597 $14808195 3980171 $11481389 29

4808096 $15157960 4530759 $12590841 20

4432117 $31958084 4274416 $26437934 21

82607 Vitamin B-12 3283484 $69600580 3208218 $54998544 27

12374324 $168495108 11889154 $139534720 21

83540 Assay of iron 2573826 $22783202 2416826 $17777978 28

1131955 $65699438 1103363 $54696192 20

3530885 $91280209 3415111 $78423161 16

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

14431323 $340218728 13470738 $278608047 22

29982902 $324139981 28708580 $256024097 27

4622255 $52313325 4523417 $43254698 21

Total 177762057 $2355233694 145644565 $1965507794 20

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 1 Lowest Rate

Percentage Medicare

Paid More Than

FEHB 1

8845138 $87510028 4014472 $79233694 10

27383560 $315644951 12603839 $285465515 11

80061 Lipid panel 20582622 $299733323 12236042 $264780532 13

6745292 $29999388 5393503 $21605942 39

4298157 $15328388 858224 $14827898 3

5058767 $15955168 3097997 $13384927 19

4599040 $33172982 4101514 $28388052 17

82607 Vitamin B-12 3348724 $70984263 3098644 $57669263 23

12652717 $172332541 11637788 $146644964 18

83540 Assay of iron 2610331 $23119240 2191250 $19978006 16

1144866 $66449427 802171 $57235817 16

3610064 $93330561 3382894 $69756354 34

14736021 $347421480 11997260 $256475682 35

30778859 $332847257 20154289 $277782489 20

4675245 $52956323 249964 $52816302 lt1

Total 182071977 $2406800929 116584937 $2045980151 18

FEHB 2 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 2 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 2

8868300 $87691704 6406107 $56925617 54

27406336 $315878919 23616591 $190298975 66

80061 Lipid panel 20620917 $300263670 17830508 $181050752 66

6803822 $30259846 5013009 $27272462 11

4312499 $15380015 801000 $14659027 5

5071508 $15995094 2423151 $15081085 6

4630130 $33399315 234400 $33218013 1

82607 Vitamin B-12 3354340 $71103569 2647056 $67236703 6

12678817 $172653909 10844674 $158505857 9

83540 Assay of iron 2611112 $23123274 2377920 $13725941 68

1140880 $66217932 1033874 $52503547 26

3616338 $93492483 3299294 $75992390 23

14761102 $348014395 13578188 $238945858 46

30827609 $333380573 22581252 $240858678 38

4703253 $53234232 4376383 $47958561 11

Total 182474941 $2410847338 130824122 $1853986362 30

FEHB 3 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 3 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 3

8870790 $87715544 5395466 $67285713 30

27406336 $315878919 16006044 $255119055 24

80061 Lipid panel 20620917 $300263670 11088845 $250104002 20

6804619 $30263393 4301384 $25300428 20

4312499 $15380015 2843481 $13316748 15

5078609 $16012775 3061511 $13696536 17

4649643 $33541369 3644077 $25746329 30

82607 Vitamin B-12 3363543 $71298574 2999341 $50209954 42

12678817 $172653909 9693743 $133570423 29

83540 Assay of iron 2625017 $23249999 2261945 $16042910 45

1154873 $67030516 1013627 $47853311 40

3616338 $93492483 3061675 $68755732 36

14761102 $348014395 12759702 $249494146 39

30827609 $333380573 24038398 $258080023 29

4703518 $53236384 4222236 $41570728 28

Total 182683830 $2416397192 128835738 $1852995878 30

and geographic area

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

Insurer

Medicare Rates

by Insurer

Medicaid 65 6 95 9 937 85 23

FEHB 1 402 38 6 1 646 61 66

FEHB 2 486 45 1 lt1 595 55 38

FEHB 3 506 45 9 1 604 54 1

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

9355762 23 $94325286 19 $1191

27232042 66 $319935253 65 $1487

80061 Lipid panel 20970947 51 $310596151 63 $1885

6709626 16 $30435748 06 $445

4416987 11 $16008487 03 $360

4805501 12 $15435365 03 $316

82607 Vitamin B-12 3334018 08 $71897559 15 $2121

12652264 30 $175307639 36 $1366

83540 Assay of iron 5455091 13 $49960956 10 $912

HCPCS Code

Description

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

3651490 09 $96028772 20 $2589

14728086 35 $353395445 72 $2364

31930801 77 $351630565 72 $1094

Total 194946397 470 $2720669830 555 NA

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

8622383 $85612322 5668213 $75265426 14

26667106 $308060147 13365771 $279044002 10

80061 Lipid panel 20096974 $293294006 9799707 $254514132 15

6636868 $29518138 6307849 $25392723 16

4153597 $14808195 3980171 $11481389 29

4808096 $15157960 4530759 $12590841 20

4432117 $31958084 4274416 $26437934 21

82607 Vitamin B-12 3283484 $69600580 3208218 $54998544 27

12374324 $168495108 11889154 $139534720 21

83540 Assay of iron 2573826 $22783202 2416826 $17777978 28

1131955 $65699438 1103363 $54696192 20

3530885 $91280209 3415111 $78423161 16

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

14431323 $340218728 13470738 $278608047 22

29982902 $324139981 28708580 $256024097 27

4622255 $52313325 4523417 $43254698 21

Total 177762057 $2355233694 145644565 $1965507794 20

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 1 Lowest Rate

Percentage Medicare

Paid More Than

FEHB 1

8845138 $87510028 4014472 $79233694 10

27383560 $315644951 12603839 $285465515 11

80061 Lipid panel 20582622 $299733323 12236042 $264780532 13

6745292 $29999388 5393503 $21605942 39

4298157 $15328388 858224 $14827898 3

5058767 $15955168 3097997 $13384927 19

4599040 $33172982 4101514 $28388052 17

82607 Vitamin B-12 3348724 $70984263 3098644 $57669263 23

12652717 $172332541 11637788 $146644964 18

83540 Assay of iron 2610331 $23119240 2191250 $19978006 16

1144866 $66449427 802171 $57235817 16

3610064 $93330561 3382894 $69756354 34

14736021 $347421480 11997260 $256475682 35

30778859 $332847257 20154289 $277782489 20

4675245 $52956323 249964 $52816302 lt1

Total 182071977 $2406800929 116584937 $2045980151 18

FEHB 2 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 2 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 2

8868300 $87691704 6406107 $56925617 54

27406336 $315878919 23616591 $190298975 66

80061 Lipid panel 20620917 $300263670 17830508 $181050752 66

6803822 $30259846 5013009 $27272462 11

4312499 $15380015 801000 $14659027 5

5071508 $15995094 2423151 $15081085 6

4630130 $33399315 234400 $33218013 1

82607 Vitamin B-12 3354340 $71103569 2647056 $67236703 6

12678817 $172653909 10844674 $158505857 9

83540 Assay of iron 2611112 $23123274 2377920 $13725941 68

1140880 $66217932 1033874 $52503547 26

3616338 $93492483 3299294 $75992390 23

14761102 $348014395 13578188 $238945858 46

30827609 $333380573 22581252 $240858678 38

4703253 $53234232 4376383 $47958561 11

Total 182474941 $2410847338 130824122 $1853986362 30

FEHB 3 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 3 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 3

8870790 $87715544 5395466 $67285713 30

27406336 $315878919 16006044 $255119055 24

80061 Lipid panel 20620917 $300263670 11088845 $250104002 20

6804619 $30263393 4301384 $25300428 20

4312499 $15380015 2843481 $13316748 15

5078609 $16012775 3061511 $13696536 17

4649643 $33541369 3644077 $25746329 30

82607 Vitamin B-12 3363543 $71298574 2999341 $50209954 42

12678817 $172653909 9693743 $133570423 29

83540 Assay of iron 2625017 $23249999 2261945 $16042910 45

1154873 $67030516 1013627 $47853311 40

3616338 $93492483 3061675 $68755732 36

14761102 $348014395 12759702 $249494146 39

30827609 $333380573 24038398 $258080023 29

4703518 $53236384 4222236 $41570728 28

Total 182683830 $2416397192 128835738 $1852995878 30

and geographic area

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

9355762 23 $94325286 19 $1191

27232042 66 $319935253 65 $1487

80061 Lipid panel 20970947 51 $310596151 63 $1885

6709626 16 $30435748 06 $445

4416987 11 $16008487 03 $360

4805501 12 $15435365 03 $316

82607 Vitamin B-12 3334018 08 $71897559 15 $2121

12652264 30 $175307639 36 $1366

83540 Assay of iron 5455091 13 $49960956 10 $912

HCPCS Code

Description

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

3651490 09 $96028772 20 $2589

14728086 35 $353395445 72 $2364

31930801 77 $351630565 72 $1094

Total 194946397 470 $2720669830 555 NA

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

8622383 $85612322 5668213 $75265426 14

26667106 $308060147 13365771 $279044002 10

80061 Lipid panel 20096974 $293294006 9799707 $254514132 15

6636868 $29518138 6307849 $25392723 16

4153597 $14808195 3980171 $11481389 29

4808096 $15157960 4530759 $12590841 20

4432117 $31958084 4274416 $26437934 21

82607 Vitamin B-12 3283484 $69600580 3208218 $54998544 27

12374324 $168495108 11889154 $139534720 21

83540 Assay of iron 2573826 $22783202 2416826 $17777978 28

1131955 $65699438 1103363 $54696192 20

3530885 $91280209 3415111 $78423161 16

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

14431323 $340218728 13470738 $278608047 22

29982902 $324139981 28708580 $256024097 27

4622255 $52313325 4523417 $43254698 21

Total 177762057 $2355233694 145644565 $1965507794 20

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 1 Lowest Rate

Percentage Medicare

Paid More Than

FEHB 1

8845138 $87510028 4014472 $79233694 10

27383560 $315644951 12603839 $285465515 11

80061 Lipid panel 20582622 $299733323 12236042 $264780532 13

6745292 $29999388 5393503 $21605942 39

4298157 $15328388 858224 $14827898 3

5058767 $15955168 3097997 $13384927 19

4599040 $33172982 4101514 $28388052 17

82607 Vitamin B-12 3348724 $70984263 3098644 $57669263 23

12652717 $172332541 11637788 $146644964 18

83540 Assay of iron 2610331 $23119240 2191250 $19978006 16

1144866 $66449427 802171 $57235817 16

3610064 $93330561 3382894 $69756354 34

14736021 $347421480 11997260 $256475682 35

30778859 $332847257 20154289 $277782489 20

4675245 $52956323 249964 $52816302 lt1

Total 182071977 $2406800929 116584937 $2045980151 18

FEHB 2 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 2 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 2

8868300 $87691704 6406107 $56925617 54

27406336 $315878919 23616591 $190298975 66

80061 Lipid panel 20620917 $300263670 17830508 $181050752 66

6803822 $30259846 5013009 $27272462 11

4312499 $15380015 801000 $14659027 5

5071508 $15995094 2423151 $15081085 6

4630130 $33399315 234400 $33218013 1

82607 Vitamin B-12 3354340 $71103569 2647056 $67236703 6

12678817 $172653909 10844674 $158505857 9

83540 Assay of iron 2611112 $23123274 2377920 $13725941 68

1140880 $66217932 1033874 $52503547 26

3616338 $93492483 3299294 $75992390 23

14761102 $348014395 13578188 $238945858 46

30827609 $333380573 22581252 $240858678 38

4703253 $53234232 4376383 $47958561 11

Total 182474941 $2410847338 130824122 $1853986362 30

FEHB 3 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 3 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 3

8870790 $87715544 5395466 $67285713 30

27406336 $315878919 16006044 $255119055 24

80061 Lipid panel 20620917 $300263670 11088845 $250104002 20

6804619 $30263393 4301384 $25300428 20

4312499 $15380015 2843481 $13316748 15

5078609 $16012775 3061511 $13696536 17

4649643 $33541369 3644077 $25746329 30

82607 Vitamin B-12 3363543 $71298574 2999341 $50209954 42

12678817 $172653909 9693743 $133570423 29

83540 Assay of iron 2625017 $23249999 2261945 $16042910 45

1154873 $67030516 1013627 $47853311 40

3616338 $93492483 3061675 $68755732 36

14761102 $348014395 12759702 $249494146 39

30827609 $333380573 24038398 $258080023 29

4703518 $53236384 4222236 $41570728 28

Total 182683830 $2416397192 128835738 $1852995878 30

and geographic area

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

9355762 23 $94325286 19 $1191

27232042 66 $319935253 65 $1487

80061 Lipid panel 20970947 51 $310596151 63 $1885

6709626 16 $30435748 06 $445

4416987 11 $16008487 03 $360

4805501 12 $15435365 03 $316

82607 Vitamin B-12 3334018 08 $71897559 15 $2121

12652264 30 $175307639 36 $1366

83540 Assay of iron 5455091 13 $49960956 10 $912

HCPCS Code

Description

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

3651490 09 $96028772 20 $2589

14728086 35 $353395445 72 $2364

31930801 77 $351630565 72 $1094

Total 194946397 470 $2720669830 555 NA

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

8622383 $85612322 5668213 $75265426 14

26667106 $308060147 13365771 $279044002 10

80061 Lipid panel 20096974 $293294006 9799707 $254514132 15

6636868 $29518138 6307849 $25392723 16

4153597 $14808195 3980171 $11481389 29

4808096 $15157960 4530759 $12590841 20

4432117 $31958084 4274416 $26437934 21

82607 Vitamin B-12 3283484 $69600580 3208218 $54998544 27

12374324 $168495108 11889154 $139534720 21

83540 Assay of iron 2573826 $22783202 2416826 $17777978 28

1131955 $65699438 1103363 $54696192 20

3530885 $91280209 3415111 $78423161 16

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

14431323 $340218728 13470738 $278608047 22

29982902 $324139981 28708580 $256024097 27

4622255 $52313325 4523417 $43254698 21

Total 177762057 $2355233694 145644565 $1965507794 20

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 1 Lowest Rate

Percentage Medicare

Paid More Than

FEHB 1

8845138 $87510028 4014472 $79233694 10

27383560 $315644951 12603839 $285465515 11

80061 Lipid panel 20582622 $299733323 12236042 $264780532 13

6745292 $29999388 5393503 $21605942 39

4298157 $15328388 858224 $14827898 3

5058767 $15955168 3097997 $13384927 19

4599040 $33172982 4101514 $28388052 17

82607 Vitamin B-12 3348724 $70984263 3098644 $57669263 23

12652717 $172332541 11637788 $146644964 18

83540 Assay of iron 2610331 $23119240 2191250 $19978006 16

1144866 $66449427 802171 $57235817 16

3610064 $93330561 3382894 $69756354 34

14736021 $347421480 11997260 $256475682 35

30778859 $332847257 20154289 $277782489 20

4675245 $52956323 249964 $52816302 lt1

Total 182071977 $2406800929 116584937 $2045980151 18

FEHB 2 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 2 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 2

8868300 $87691704 6406107 $56925617 54

27406336 $315878919 23616591 $190298975 66

80061 Lipid panel 20620917 $300263670 17830508 $181050752 66

6803822 $30259846 5013009 $27272462 11

4312499 $15380015 801000 $14659027 5

5071508 $15995094 2423151 $15081085 6

4630130 $33399315 234400 $33218013 1

82607 Vitamin B-12 3354340 $71103569 2647056 $67236703 6

12678817 $172653909 10844674 $158505857 9

83540 Assay of iron 2611112 $23123274 2377920 $13725941 68

1140880 $66217932 1033874 $52503547 26

3616338 $93492483 3299294 $75992390 23

14761102 $348014395 13578188 $238945858 46

30827609 $333380573 22581252 $240858678 38

4703253 $53234232 4376383 $47958561 11

Total 182474941 $2410847338 130824122 $1853986362 30

FEHB 3 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 3 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 3

8870790 $87715544 5395466 $67285713 30

27406336 $315878919 16006044 $255119055 24

80061 Lipid panel 20620917 $300263670 11088845 $250104002 20

6804619 $30263393 4301384 $25300428 20

4312499 $15380015 2843481 $13316748 15

5078609 $16012775 3061511 $13696536 17

4649643 $33541369 3644077 $25746329 30

82607 Vitamin B-12 3363543 $71298574 2999341 $50209954 42

12678817 $172653909 9693743 $133570423 29

83540 Assay of iron 2625017 $23249999 2261945 $16042910 45

1154873 $67030516 1013627 $47853311 40

3616338 $93492483 3061675 $68755732 36

14761102 $348014395 12759702 $249494146 39

30827609 $333380573 24038398 $258080023 29

4703518 $53236384 4222236 $41570728 28

Total 182683830 $2416397192 128835738 $1852995878 30

and geographic area

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

9355762 23 $94325286 19 $1191

27232042 66 $319935253 65 $1487

80061 Lipid panel 20970947 51 $310596151 63 $1885

6709626 16 $30435748 06 $445

4416987 11 $16008487 03 $360

4805501 12 $15435365 03 $316

82607 Vitamin B-12 3334018 08 $71897559 15 $2121

12652264 30 $175307639 36 $1366

83540 Assay of iron 5455091 13 $49960956 10 $912

HCPCS Code

Description

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

3651490 09 $96028772 20 $2589

14728086 35 $353395445 72 $2364

31930801 77 $351630565 72 $1094

Total 194946397 470 $2720669830 555 NA

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

8622383 $85612322 5668213 $75265426 14

26667106 $308060147 13365771 $279044002 10

80061 Lipid panel 20096974 $293294006 9799707 $254514132 15

6636868 $29518138 6307849 $25392723 16

4153597 $14808195 3980171 $11481389 29

4808096 $15157960 4530759 $12590841 20

4432117 $31958084 4274416 $26437934 21

82607 Vitamin B-12 3283484 $69600580 3208218 $54998544 27

12374324 $168495108 11889154 $139534720 21

83540 Assay of iron 2573826 $22783202 2416826 $17777978 28

1131955 $65699438 1103363 $54696192 20

3530885 $91280209 3415111 $78423161 16

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

14431323 $340218728 13470738 $278608047 22

29982902 $324139981 28708580 $256024097 27

4622255 $52313325 4523417 $43254698 21

Total 177762057 $2355233694 145644565 $1965507794 20

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 1 Lowest Rate

Percentage Medicare

Paid More Than

FEHB 1

8845138 $87510028 4014472 $79233694 10

27383560 $315644951 12603839 $285465515 11

80061 Lipid panel 20582622 $299733323 12236042 $264780532 13

6745292 $29999388 5393503 $21605942 39

4298157 $15328388 858224 $14827898 3

5058767 $15955168 3097997 $13384927 19

4599040 $33172982 4101514 $28388052 17

82607 Vitamin B-12 3348724 $70984263 3098644 $57669263 23

12652717 $172332541 11637788 $146644964 18

83540 Assay of iron 2610331 $23119240 2191250 $19978006 16

1144866 $66449427 802171 $57235817 16

3610064 $93330561 3382894 $69756354 34

14736021 $347421480 11997260 $256475682 35

30778859 $332847257 20154289 $277782489 20

4675245 $52956323 249964 $52816302 lt1

Total 182071977 $2406800929 116584937 $2045980151 18

FEHB 2 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 2 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 2

8868300 $87691704 6406107 $56925617 54

27406336 $315878919 23616591 $190298975 66

80061 Lipid panel 20620917 $300263670 17830508 $181050752 66

6803822 $30259846 5013009 $27272462 11

4312499 $15380015 801000 $14659027 5

5071508 $15995094 2423151 $15081085 6

4630130 $33399315 234400 $33218013 1

82607 Vitamin B-12 3354340 $71103569 2647056 $67236703 6

12678817 $172653909 10844674 $158505857 9

83540 Assay of iron 2611112 $23123274 2377920 $13725941 68

1140880 $66217932 1033874 $52503547 26

3616338 $93492483 3299294 $75992390 23

14761102 $348014395 13578188 $238945858 46

30827609 $333380573 22581252 $240858678 38

4703253 $53234232 4376383 $47958561 11

Total 182474941 $2410847338 130824122 $1853986362 30

FEHB 3 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 3 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 3

8870790 $87715544 5395466 $67285713 30

27406336 $315878919 16006044 $255119055 24

80061 Lipid panel 20620917 $300263670 11088845 $250104002 20

6804619 $30263393 4301384 $25300428 20

4312499 $15380015 2843481 $13316748 15

5078609 $16012775 3061511 $13696536 17

4649643 $33541369 3644077 $25746329 30

82607 Vitamin B-12 3363543 $71298574 2999341 $50209954 42

12678817 $172653909 9693743 $133570423 29

83540 Assay of iron 2625017 $23249999 2261945 $16042910 45

1154873 $67030516 1013627 $47853311 40

3616338 $93492483 3061675 $68755732 36

14761102 $348014395 12759702 $249494146 39

30827609 $333380573 24038398 $258080023 29

4703518 $53236384 4222236 $41570728 28

Total 182683830 $2416397192 128835738 $1852995878 30

and geographic area

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

9355762 23 $94325286 19 $1191

27232042 66 $319935253 65 $1487

80061 Lipid panel 20970947 51 $310596151 63 $1885

6709626 16 $30435748 06 $445

4416987 11 $16008487 03 $360

4805501 12 $15435365 03 $316

82607 Vitamin B-12 3334018 08 $71897559 15 $2121

12652264 30 $175307639 36 $1366

83540 Assay of iron 5455091 13 $49960956 10 $912

HCPCS Code

Description

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

3651490 09 $96028772 20 $2589

14728086 35 $353395445 72 $2364

31930801 77 $351630565 72 $1094

Total 194946397 470 $2720669830 555 NA

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

8622383 $85612322 5668213 $75265426 14

26667106 $308060147 13365771 $279044002 10

80061 Lipid panel 20096974 $293294006 9799707 $254514132 15

6636868 $29518138 6307849 $25392723 16

4153597 $14808195 3980171 $11481389 29

4808096 $15157960 4530759 $12590841 20

4432117 $31958084 4274416 $26437934 21

82607 Vitamin B-12 3283484 $69600580 3208218 $54998544 27

12374324 $168495108 11889154 $139534720 21

83540 Assay of iron 2573826 $22783202 2416826 $17777978 28

1131955 $65699438 1103363 $54696192 20

3530885 $91280209 3415111 $78423161 16

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

14431323 $340218728 13470738 $278608047 22

29982902 $324139981 28708580 $256024097 27

4622255 $52313325 4523417 $43254698 21

Total 177762057 $2355233694 145644565 $1965507794 20

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 1 Lowest Rate

Percentage Medicare

Paid More Than

FEHB 1

8845138 $87510028 4014472 $79233694 10

27383560 $315644951 12603839 $285465515 11

80061 Lipid panel 20582622 $299733323 12236042 $264780532 13

6745292 $29999388 5393503 $21605942 39

4298157 $15328388 858224 $14827898 3

5058767 $15955168 3097997 $13384927 19

4599040 $33172982 4101514 $28388052 17

82607 Vitamin B-12 3348724 $70984263 3098644 $57669263 23

12652717 $172332541 11637788 $146644964 18

83540 Assay of iron 2610331 $23119240 2191250 $19978006 16

1144866 $66449427 802171 $57235817 16

3610064 $93330561 3382894 $69756354 34

14736021 $347421480 11997260 $256475682 35

30778859 $332847257 20154289 $277782489 20

4675245 $52956323 249964 $52816302 lt1

Total 182071977 $2406800929 116584937 $2045980151 18

FEHB 2 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 2 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 2

8868300 $87691704 6406107 $56925617 54

27406336 $315878919 23616591 $190298975 66

80061 Lipid panel 20620917 $300263670 17830508 $181050752 66

6803822 $30259846 5013009 $27272462 11

4312499 $15380015 801000 $14659027 5

5071508 $15995094 2423151 $15081085 6

4630130 $33399315 234400 $33218013 1

82607 Vitamin B-12 3354340 $71103569 2647056 $67236703 6

12678817 $172653909 10844674 $158505857 9

83540 Assay of iron 2611112 $23123274 2377920 $13725941 68

1140880 $66217932 1033874 $52503547 26

3616338 $93492483 3299294 $75992390 23

14761102 $348014395 13578188 $238945858 46

30827609 $333380573 22581252 $240858678 38

4703253 $53234232 4376383 $47958561 11

Total 182474941 $2410847338 130824122 $1853986362 30

FEHB 3 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 3 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 3

8870790 $87715544 5395466 $67285713 30

27406336 $315878919 16006044 $255119055 24

80061 Lipid panel 20620917 $300263670 11088845 $250104002 20

6804619 $30263393 4301384 $25300428 20

4312499 $15380015 2843481 $13316748 15

5078609 $16012775 3061511 $13696536 17

4649643 $33541369 3644077 $25746329 30

82607 Vitamin B-12 3363543 $71298574 2999341 $50209954 42

12678817 $172653909 9693743 $133570423 29

83540 Assay of iron 2625017 $23249999 2261945 $16042910 45

1154873 $67030516 1013627 $47853311 40

3616338 $93492483 3061675 $68755732 36

14761102 $348014395 12759702 $249494146 39

30827609 $333380573 24038398 $258080023 29

4703518 $53236384 4222236 $41570728 28

Total 182683830 $2416397192 128835738 $1852995878 30

and geographic area

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

9355762 23 $94325286 19 $1191

27232042 66 $319935253 65 $1487

80061 Lipid panel 20970947 51 $310596151 63 $1885

6709626 16 $30435748 06 $445

4416987 11 $16008487 03 $360

4805501 12 $15435365 03 $316

82607 Vitamin B-12 3334018 08 $71897559 15 $2121

12652264 30 $175307639 36 $1366

83540 Assay of iron 5455091 13 $49960956 10 $912

HCPCS Code

Description

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

3651490 09 $96028772 20 $2589

14728086 35 $353395445 72 $2364

31930801 77 $351630565 72 $1094

Total 194946397 470 $2720669830 555 NA

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

8622383 $85612322 5668213 $75265426 14

26667106 $308060147 13365771 $279044002 10

80061 Lipid panel 20096974 $293294006 9799707 $254514132 15

6636868 $29518138 6307849 $25392723 16

4153597 $14808195 3980171 $11481389 29

4808096 $15157960 4530759 $12590841 20

4432117 $31958084 4274416 $26437934 21

82607 Vitamin B-12 3283484 $69600580 3208218 $54998544 27

12374324 $168495108 11889154 $139534720 21

83540 Assay of iron 2573826 $22783202 2416826 $17777978 28

1131955 $65699438 1103363 $54696192 20

3530885 $91280209 3415111 $78423161 16

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

14431323 $340218728 13470738 $278608047 22

29982902 $324139981 28708580 $256024097 27

4622255 $52313325 4523417 $43254698 21

Total 177762057 $2355233694 145644565 $1965507794 20

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 1 Lowest Rate

Percentage Medicare

Paid More Than

FEHB 1

8845138 $87510028 4014472 $79233694 10

27383560 $315644951 12603839 $285465515 11

80061 Lipid panel 20582622 $299733323 12236042 $264780532 13

6745292 $29999388 5393503 $21605942 39

4298157 $15328388 858224 $14827898 3

5058767 $15955168 3097997 $13384927 19

4599040 $33172982 4101514 $28388052 17

82607 Vitamin B-12 3348724 $70984263 3098644 $57669263 23

12652717 $172332541 11637788 $146644964 18

83540 Assay of iron 2610331 $23119240 2191250 $19978006 16

1144866 $66449427 802171 $57235817 16

3610064 $93330561 3382894 $69756354 34

14736021 $347421480 11997260 $256475682 35

30778859 $332847257 20154289 $277782489 20

4675245 $52956323 249964 $52816302 lt1

Total 182071977 $2406800929 116584937 $2045980151 18

FEHB 2 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 2 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 2

8868300 $87691704 6406107 $56925617 54

27406336 $315878919 23616591 $190298975 66

80061 Lipid panel 20620917 $300263670 17830508 $181050752 66

6803822 $30259846 5013009 $27272462 11

4312499 $15380015 801000 $14659027 5

5071508 $15995094 2423151 $15081085 6

4630130 $33399315 234400 $33218013 1

82607 Vitamin B-12 3354340 $71103569 2647056 $67236703 6

12678817 $172653909 10844674 $158505857 9

83540 Assay of iron 2611112 $23123274 2377920 $13725941 68

1140880 $66217932 1033874 $52503547 26

3616338 $93492483 3299294 $75992390 23

14761102 $348014395 13578188 $238945858 46

30827609 $333380573 22581252 $240858678 38

4703253 $53234232 4376383 $47958561 11

Total 182474941 $2410847338 130824122 $1853986362 30

FEHB 3 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 3 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 3

8870790 $87715544 5395466 $67285713 30

27406336 $315878919 16006044 $255119055 24

80061 Lipid panel 20620917 $300263670 11088845 $250104002 20

6804619 $30263393 4301384 $25300428 20

4312499 $15380015 2843481 $13316748 15

5078609 $16012775 3061511 $13696536 17

4649643 $33541369 3644077 $25746329 30

82607 Vitamin B-12 3363543 $71298574 2999341 $50209954 42

12678817 $172653909 9693743 $133570423 29

83540 Assay of iron 2625017 $23249999 2261945 $16042910 45

1154873 $67030516 1013627 $47853311 40

3616338 $93492483 3061675 $68755732 36

14761102 $348014395 12759702 $249494146 39

30827609 $333380573 24038398 $258080023 29

4703518 $53236384 4222236 $41570728 28

Total 182683830 $2416397192 128835738 $1852995878 30

and geographic area

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

9355762 23 $94325286 19 $1191

27232042 66 $319935253 65 $1487

80061 Lipid panel 20970947 51 $310596151 63 $1885

6709626 16 $30435748 06 $445

4416987 11 $16008487 03 $360

4805501 12 $15435365 03 $316

82607 Vitamin B-12 3334018 08 $71897559 15 $2121

12652264 30 $175307639 36 $1366

83540 Assay of iron 5455091 13 $49960956 10 $912

HCPCS Code

Description

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

3651490 09 $96028772 20 $2589

14728086 35 $353395445 72 $2364

31930801 77 $351630565 72 $1094

Total 194946397 470 $2720669830 555 NA

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

8622383 $85612322 5668213 $75265426 14

26667106 $308060147 13365771 $279044002 10

80061 Lipid panel 20096974 $293294006 9799707 $254514132 15

6636868 $29518138 6307849 $25392723 16

4153597 $14808195 3980171 $11481389 29

4808096 $15157960 4530759 $12590841 20

4432117 $31958084 4274416 $26437934 21

82607 Vitamin B-12 3283484 $69600580 3208218 $54998544 27

12374324 $168495108 11889154 $139534720 21

83540 Assay of iron 2573826 $22783202 2416826 $17777978 28

1131955 $65699438 1103363 $54696192 20

3530885 $91280209 3415111 $78423161 16

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

14431323 $340218728 13470738 $278608047 22

29982902 $324139981 28708580 $256024097 27

4622255 $52313325 4523417 $43254698 21

Total 177762057 $2355233694 145644565 $1965507794 20

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 1 Lowest Rate

Percentage Medicare

Paid More Than

FEHB 1

8845138 $87510028 4014472 $79233694 10

27383560 $315644951 12603839 $285465515 11

80061 Lipid panel 20582622 $299733323 12236042 $264780532 13

6745292 $29999388 5393503 $21605942 39

4298157 $15328388 858224 $14827898 3

5058767 $15955168 3097997 $13384927 19

4599040 $33172982 4101514 $28388052 17

82607 Vitamin B-12 3348724 $70984263 3098644 $57669263 23

12652717 $172332541 11637788 $146644964 18

83540 Assay of iron 2610331 $23119240 2191250 $19978006 16

1144866 $66449427 802171 $57235817 16

3610064 $93330561 3382894 $69756354 34

14736021 $347421480 11997260 $256475682 35

30778859 $332847257 20154289 $277782489 20

4675245 $52956323 249964 $52816302 lt1

Total 182071977 $2406800929 116584937 $2045980151 18

FEHB 2 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 2 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 2

8868300 $87691704 6406107 $56925617 54

27406336 $315878919 23616591 $190298975 66

80061 Lipid panel 20620917 $300263670 17830508 $181050752 66

6803822 $30259846 5013009 $27272462 11

4312499 $15380015 801000 $14659027 5

5071508 $15995094 2423151 $15081085 6

4630130 $33399315 234400 $33218013 1

82607 Vitamin B-12 3354340 $71103569 2647056 $67236703 6

12678817 $172653909 10844674 $158505857 9

83540 Assay of iron 2611112 $23123274 2377920 $13725941 68

1140880 $66217932 1033874 $52503547 26

3616338 $93492483 3299294 $75992390 23

14761102 $348014395 13578188 $238945858 46

30827609 $333380573 22581252 $240858678 38

4703253 $53234232 4376383 $47958561 11

Total 182474941 $2410847338 130824122 $1853986362 30

FEHB 3 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 3 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 3

8870790 $87715544 5395466 $67285713 30

27406336 $315878919 16006044 $255119055 24

80061 Lipid panel 20620917 $300263670 11088845 $250104002 20

6804619 $30263393 4301384 $25300428 20

4312499 $15380015 2843481 $13316748 15

5078609 $16012775 3061511 $13696536 17

4649643 $33541369 3644077 $25746329 30

82607 Vitamin B-12 3363543 $71298574 2999341 $50209954 42

12678817 $172653909 9693743 $133570423 29

83540 Assay of iron 2625017 $23249999 2261945 $16042910 45

1154873 $67030516 1013627 $47853311 40

3616338 $93492483 3061675 $68755732 36

14761102 $348014395 12759702 $249494146 39

30827609 $333380573 24038398 $258080023 29

4703518 $53236384 4222236 $41570728 28

Total 182683830 $2416397192 128835738 $1852995878 30

and geographic area

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

HCPCS Code

Description

Number of

Percentage of All

Total Medicare-

Allowed Amount in

Percentage of Total

Medicare-Allowed

Amount in 2010

3651490 09 $96028772 20 $2589

14728086 35 $353395445 72 $2364

31930801 77 $351630565 72 $1094

Total 194946397 470 $2720669830 555 NA

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

8622383 $85612322 5668213 $75265426 14

26667106 $308060147 13365771 $279044002 10

80061 Lipid panel 20096974 $293294006 9799707 $254514132 15

6636868 $29518138 6307849 $25392723 16

4153597 $14808195 3980171 $11481389 29

4808096 $15157960 4530759 $12590841 20

4432117 $31958084 4274416 $26437934 21

82607 Vitamin B-12 3283484 $69600580 3208218 $54998544 27

12374324 $168495108 11889154 $139534720 21

83540 Assay of iron 2573826 $22783202 2416826 $17777978 28

1131955 $65699438 1103363 $54696192 20

3530885 $91280209 3415111 $78423161 16

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

14431323 $340218728 13470738 $278608047 22

29982902 $324139981 28708580 $256024097 27

4622255 $52313325 4523417 $43254698 21

Total 177762057 $2355233694 145644565 $1965507794 20

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 1 Lowest Rate

Percentage Medicare

Paid More Than

FEHB 1

8845138 $87510028 4014472 $79233694 10

27383560 $315644951 12603839 $285465515 11

80061 Lipid panel 20582622 $299733323 12236042 $264780532 13

6745292 $29999388 5393503 $21605942 39

4298157 $15328388 858224 $14827898 3

5058767 $15955168 3097997 $13384927 19

4599040 $33172982 4101514 $28388052 17

82607 Vitamin B-12 3348724 $70984263 3098644 $57669263 23

12652717 $172332541 11637788 $146644964 18

83540 Assay of iron 2610331 $23119240 2191250 $19978006 16

1144866 $66449427 802171 $57235817 16

3610064 $93330561 3382894 $69756354 34

14736021 $347421480 11997260 $256475682 35

30778859 $332847257 20154289 $277782489 20

4675245 $52956323 249964 $52816302 lt1

Total 182071977 $2406800929 116584937 $2045980151 18

FEHB 2 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 2 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 2

8868300 $87691704 6406107 $56925617 54

27406336 $315878919 23616591 $190298975 66

80061 Lipid panel 20620917 $300263670 17830508 $181050752 66

6803822 $30259846 5013009 $27272462 11

4312499 $15380015 801000 $14659027 5

5071508 $15995094 2423151 $15081085 6

4630130 $33399315 234400 $33218013 1

82607 Vitamin B-12 3354340 $71103569 2647056 $67236703 6

12678817 $172653909 10844674 $158505857 9

83540 Assay of iron 2611112 $23123274 2377920 $13725941 68

1140880 $66217932 1033874 $52503547 26

3616338 $93492483 3299294 $75992390 23

14761102 $348014395 13578188 $238945858 46

30827609 $333380573 22581252 $240858678 38

4703253 $53234232 4376383 $47958561 11

Total 182474941 $2410847338 130824122 $1853986362 30

FEHB 3 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 3 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 3

8870790 $87715544 5395466 $67285713 30

27406336 $315878919 16006044 $255119055 24

80061 Lipid panel 20620917 $300263670 11088845 $250104002 20

6804619 $30263393 4301384 $25300428 20

4312499 $15380015 2843481 $13316748 15

5078609 $16012775 3061511 $13696536 17

4649643 $33541369 3644077 $25746329 30

82607 Vitamin B-12 3363543 $71298574 2999341 $50209954 42

12678817 $172653909 9693743 $133570423 29

83540 Assay of iron 2625017 $23249999 2261945 $16042910 45

1154873 $67030516 1013627 $47853311 40

3616338 $93492483 3061675 $68755732 36

14761102 $348014395 12759702 $249494146 39

30827609 $333380573 24038398 $258080023 29

4703518 $53236384 4222236 $41570728 28

Total 182683830 $2416397192 128835738 $1852995878 30

and geographic area

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

8622383 $85612322 5668213 $75265426 14

26667106 $308060147 13365771 $279044002 10

80061 Lipid panel 20096974 $293294006 9799707 $254514132 15

6636868 $29518138 6307849 $25392723 16

4153597 $14808195 3980171 $11481389 29

4808096 $15157960 4530759 $12590841 20

4432117 $31958084 4274416 $26437934 21

82607 Vitamin B-12 3283484 $69600580 3208218 $54998544 27

12374324 $168495108 11889154 $139534720 21

83540 Assay of iron 2573826 $22783202 2416826 $17777978 28

1131955 $65699438 1103363 $54696192 20

3530885 $91280209 3415111 $78423161 16

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

14431323 $340218728 13470738 $278608047 22

29982902 $324139981 28708580 $256024097 27

4622255 $52313325 4523417 $43254698 21

Total 177762057 $2355233694 145644565 $1965507794 20

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 1 Lowest Rate

Percentage Medicare

Paid More Than

FEHB 1

8845138 $87510028 4014472 $79233694 10

27383560 $315644951 12603839 $285465515 11

80061 Lipid panel 20582622 $299733323 12236042 $264780532 13

6745292 $29999388 5393503 $21605942 39

4298157 $15328388 858224 $14827898 3

5058767 $15955168 3097997 $13384927 19

4599040 $33172982 4101514 $28388052 17

82607 Vitamin B-12 3348724 $70984263 3098644 $57669263 23

12652717 $172332541 11637788 $146644964 18

83540 Assay of iron 2610331 $23119240 2191250 $19978006 16

1144866 $66449427 802171 $57235817 16

3610064 $93330561 3382894 $69756354 34

14736021 $347421480 11997260 $256475682 35

30778859 $332847257 20154289 $277782489 20

4675245 $52956323 249964 $52816302 lt1

Total 182071977 $2406800929 116584937 $2045980151 18

FEHB 2 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 2 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 2

8868300 $87691704 6406107 $56925617 54

27406336 $315878919 23616591 $190298975 66

80061 Lipid panel 20620917 $300263670 17830508 $181050752 66

6803822 $30259846 5013009 $27272462 11

4312499 $15380015 801000 $14659027 5

5071508 $15995094 2423151 $15081085 6

4630130 $33399315 234400 $33218013 1

82607 Vitamin B-12 3354340 $71103569 2647056 $67236703 6

12678817 $172653909 10844674 $158505857 9

83540 Assay of iron 2611112 $23123274 2377920 $13725941 68

1140880 $66217932 1033874 $52503547 26

3616338 $93492483 3299294 $75992390 23

14761102 $348014395 13578188 $238945858 46

30827609 $333380573 22581252 $240858678 38

4703253 $53234232 4376383 $47958561 11

Total 182474941 $2410847338 130824122 $1853986362 30

FEHB 3 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 3 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 3

8870790 $87715544 5395466 $67285713 30

27406336 $315878919 16006044 $255119055 24

80061 Lipid panel 20620917 $300263670 11088845 $250104002 20

6804619 $30263393 4301384 $25300428 20

4312499 $15380015 2843481 $13316748 15

5078609 $16012775 3061511 $13696536 17

4649643 $33541369 3644077 $25746329 30

82607 Vitamin B-12 3363543 $71298574 2999341 $50209954 42

12678817 $172653909 9693743 $133570423 29

83540 Assay of iron 2625017 $23249999 2261945 $16042910 45

1154873 $67030516 1013627 $47853311 40

3616338 $93492483 3061675 $68755732 36

14761102 $348014395 12759702 $249494146 39

30827609 $333380573 24038398 $258080023 29

4703518 $53236384 4222236 $41570728 28

Total 182683830 $2416397192 128835738 $1852995878 30

and geographic area

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Lowest Rate Used

Percentage Medicare

Paid More Than

Medicaid

14431323 $340218728 13470738 $278608047 22

29982902 $324139981 28708580 $256024097 27

4622255 $52313325 4523417 $43254698 21

Total 177762057 $2355233694 145644565 $1965507794 20

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 1 Lowest Rate

Percentage Medicare

Paid More Than

FEHB 1

8845138 $87510028 4014472 $79233694 10

27383560 $315644951 12603839 $285465515 11

80061 Lipid panel 20582622 $299733323 12236042 $264780532 13

6745292 $29999388 5393503 $21605942 39

4298157 $15328388 858224 $14827898 3

5058767 $15955168 3097997 $13384927 19

4599040 $33172982 4101514 $28388052 17

82607 Vitamin B-12 3348724 $70984263 3098644 $57669263 23

12652717 $172332541 11637788 $146644964 18

83540 Assay of iron 2610331 $23119240 2191250 $19978006 16

1144866 $66449427 802171 $57235817 16

3610064 $93330561 3382894 $69756354 34

14736021 $347421480 11997260 $256475682 35

30778859 $332847257 20154289 $277782489 20

4675245 $52956323 249964 $52816302 lt1

Total 182071977 $2406800929 116584937 $2045980151 18

FEHB 2 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 2 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 2

8868300 $87691704 6406107 $56925617 54

27406336 $315878919 23616591 $190298975 66

80061 Lipid panel 20620917 $300263670 17830508 $181050752 66

6803822 $30259846 5013009 $27272462 11

4312499 $15380015 801000 $14659027 5

5071508 $15995094 2423151 $15081085 6

4630130 $33399315 234400 $33218013 1

82607 Vitamin B-12 3354340 $71103569 2647056 $67236703 6

12678817 $172653909 10844674 $158505857 9

83540 Assay of iron 2611112 $23123274 2377920 $13725941 68

1140880 $66217932 1033874 $52503547 26

3616338 $93492483 3299294 $75992390 23

14761102 $348014395 13578188 $238945858 46

30827609 $333380573 22581252 $240858678 38

4703253 $53234232 4376383 $47958561 11

Total 182474941 $2410847338 130824122 $1853986362 30

FEHB 3 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 3 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 3

8870790 $87715544 5395466 $67285713 30

27406336 $315878919 16006044 $255119055 24

80061 Lipid panel 20620917 $300263670 11088845 $250104002 20

6804619 $30263393 4301384 $25300428 20

4312499 $15380015 2843481 $13316748 15

5078609 $16012775 3061511 $13696536 17

4649643 $33541369 3644077 $25746329 30

82607 Vitamin B-12 3363543 $71298574 2999341 $50209954 42

12678817 $172653909 9693743 $133570423 29

83540 Assay of iron 2625017 $23249999 2261945 $16042910 45

1154873 $67030516 1013627 $47853311 40

3616338 $93492483 3061675 $68755732 36

14761102 $348014395 12759702 $249494146 39

30827609 $333380573 24038398 $258080023 29

4703518 $53236384 4222236 $41570728 28

Total 182683830 $2416397192 128835738 $1852995878 30

and geographic area

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 1 Lowest Rate

Percentage Medicare

Paid More Than

FEHB 1

8845138 $87510028 4014472 $79233694 10

27383560 $315644951 12603839 $285465515 11

80061 Lipid panel 20582622 $299733323 12236042 $264780532 13

6745292 $29999388 5393503 $21605942 39

4298157 $15328388 858224 $14827898 3

5058767 $15955168 3097997 $13384927 19

4599040 $33172982 4101514 $28388052 17

82607 Vitamin B-12 3348724 $70984263 3098644 $57669263 23

12652717 $172332541 11637788 $146644964 18

83540 Assay of iron 2610331 $23119240 2191250 $19978006 16

1144866 $66449427 802171 $57235817 16

3610064 $93330561 3382894 $69756354 34

14736021 $347421480 11997260 $256475682 35

30778859 $332847257 20154289 $277782489 20

4675245 $52956323 249964 $52816302 lt1

Total 182071977 $2406800929 116584937 $2045980151 18

FEHB 2 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 2 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 2

8868300 $87691704 6406107 $56925617 54

27406336 $315878919 23616591 $190298975 66

80061 Lipid panel 20620917 $300263670 17830508 $181050752 66

6803822 $30259846 5013009 $27272462 11

4312499 $15380015 801000 $14659027 5

5071508 $15995094 2423151 $15081085 6

4630130 $33399315 234400 $33218013 1

82607 Vitamin B-12 3354340 $71103569 2647056 $67236703 6

12678817 $172653909 10844674 $158505857 9

83540 Assay of iron 2611112 $23123274 2377920 $13725941 68

1140880 $66217932 1033874 $52503547 26

3616338 $93492483 3299294 $75992390 23

14761102 $348014395 13578188 $238945858 46

30827609 $333380573 22581252 $240858678 38

4703253 $53234232 4376383 $47958561 11

Total 182474941 $2410847338 130824122 $1853986362 30

FEHB 3 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 3 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 3

8870790 $87715544 5395466 $67285713 30

27406336 $315878919 16006044 $255119055 24

80061 Lipid panel 20620917 $300263670 11088845 $250104002 20

6804619 $30263393 4301384 $25300428 20

4312499 $15380015 2843481 $13316748 15

5078609 $16012775 3061511 $13696536 17

4649643 $33541369 3644077 $25746329 30

82607 Vitamin B-12 3363543 $71298574 2999341 $50209954 42

12678817 $172653909 9693743 $133570423 29

83540 Assay of iron 2625017 $23249999 2261945 $16042910 45

1154873 $67030516 1013627 $47853311 40

3616338 $93492483 3061675 $68755732 36

14761102 $348014395 12759702 $249494146 39

30827609 $333380573 24038398 $258080023 29

4703518 $53236384 4222236 $41570728 28

Total 182683830 $2416397192 128835738 $1852995878 30

and geographic area

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

FEHB 2 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 2 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 2

8868300 $87691704 6406107 $56925617 54

27406336 $315878919 23616591 $190298975 66

80061 Lipid panel 20620917 $300263670 17830508 $181050752 66

6803822 $30259846 5013009 $27272462 11

4312499 $15380015 801000 $14659027 5

5071508 $15995094 2423151 $15081085 6

4630130 $33399315 234400 $33218013 1

82607 Vitamin B-12 3354340 $71103569 2647056 $67236703 6

12678817 $172653909 10844674 $158505857 9

83540 Assay of iron 2611112 $23123274 2377920 $13725941 68

1140880 $66217932 1033874 $52503547 26

3616338 $93492483 3299294 $75992390 23

14761102 $348014395 13578188 $238945858 46

30827609 $333380573 22581252 $240858678 38

4703253 $53234232 4376383 $47958561 11

Total 182474941 $2410847338 130824122 $1853986362 30

FEHB 3 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 3 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 3

8870790 $87715544 5395466 $67285713 30

27406336 $315878919 16006044 $255119055 24

80061 Lipid panel 20620917 $300263670 11088845 $250104002 20

6804619 $30263393 4301384 $25300428 20

4312499 $15380015 2843481 $13316748 15

5078609 $16012775 3061511 $13696536 17

4649643 $33541369 3644077 $25746329 30

82607 Vitamin B-12 3363543 $71298574 2999341 $50209954 42

12678817 $172653909 9693743 $133570423 29

83540 Assay of iron 2625017 $23249999 2261945 $16042910 45

1154873 $67030516 1013627 $47853311 40

3616338 $93492483 3061675 $68755732 36

14761102 $348014395 12759702 $249494146 39

30827609 $333380573 24038398 $258080023 29

4703518 $53236384 4222236 $41570728 28

Total 182683830 $2416397192 128835738 $1852995878 30

and geographic area

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

FEHB 3 Rates

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Allowed Amount If

FEHB 3 Lowest

Rate Used

Percentage Medicare

Paid More Than

FEHB 3

8870790 $87715544 5395466 $67285713 30

27406336 $315878919 16006044 $255119055 24

80061 Lipid panel 20620917 $300263670 11088845 $250104002 20

6804619 $30263393 4301384 $25300428 20

4312499 $15380015 2843481 $13316748 15

5078609 $16012775 3061511 $13696536 17

4649643 $33541369 3644077 $25746329 30

82607 Vitamin B-12 3363543 $71298574 2999341 $50209954 42

12678817 $172653909 9693743 $133570423 29

83540 Assay of iron 2625017 $23249999 2261945 $16042910 45

1154873 $67030516 1013627 $47853311 40

3616338 $93492483 3061675 $68755732 36

14761102 $348014395 12759702 $249494146 39

30827609 $333380573 24038398 $258080023 29

4703518 $53236384 4222236 $41570728 28

Total 182683830 $2416397192 128835738 $1852995878 30

and geographic area

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

and geographic area

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

HCPCS Code

Insurer State

AK AL AR AZ CA

$1191 $1212 $710 $498

$1191 $1100 $1255 $1597 $788

$1191 $1209 $1840 $1454 $1509

$1191 $1151 $958 $498 $723

$1191 $927 $958 $498

$1487 $1514 $1156 $619

$1487 $1200 $1400 $819 $984

$1487 $1510 $1817 $1932 $2216

$1487 $1438 $1156 $619 $903

$1487 $1157 $1156 $619

$1885 $1919 $1369 $820

$1599 $1400 $1369 $820

$1789 $1816 $2185 $2185 $2666

$1885 $1823 $1369 $820

$1885 $1374 $1318 $820

$445 $454 $274 $554

$445 $400 $274 $566 $550

$445 $452 $797 $665 $665

$445 $431 $274 $515 $271

$445 $347 $270 $380 $384

$360 $366

NA $561

$360 $300 $700 $482 $450

$360 $366 $673 $439 $536

$360 $348 $375 $415 $343

$360 $280 $586 $600 $311

$316 $322 $521 $285

$316 $300 $500 $424 $450

$316 $320 $565 $386 $471

$316 $306 $211 $285 $196

$316 $246 $219 $377 $273

$4166 $4240 $3486 $5773 $9000

$4166 $2900 $4388 $5773 $3392

$4166 $4227 $3621 $5773 $6204

$3259 $3151 $3621 $5773 $1977

$4166 $2454 $3486 $5773 $3592

$728 $741 $579

$1303 $2687

$728 $600 $767 $802 $759

$728 $739 $668

$1085 $1085

$728 $704 $602

$1013 $519

$728 $527 $602

$1303 $628

$2121 $2159 $1603 $1971 $3670

$2121 $1700 $2234 $2800 $1727

$2121 $2152 $2317 $2713 $3159

$2121 $2051 $1665 $1971 $1275

$2121 $1649 $1665 $1971 $1829

$1917 $1951

NA $1638 $2087

$1917 $1300 $2019 $1620 $1561

$1917 $1946 $2341 $2341 $2855

$1917 $1853 $1561 $1638 $1163

$1917 $1491 $1561 $1638 $1652

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

HCPCS Code

Insurer State

AK AL AR AZ CA

$1366 $1390 $1145 $1235 $6150

$1366 $1200 $1145 $1467 $1390

$1366 $1387 $1492 $1700 $2034

$1366 $1321 $1102 $1235 $816

$1366 $1063 $1124 $1235 $1178

$912 $928 $751 $512 $835

$912 $700 $780 $210 $557

$912 $925

$1560 $1114 $1358

$912 $882 $751 $512 $553

$912 $709 $751 $512 $786

$1230 $1252 $957

$1228 $1465

$1230 $1000 $1295 $945 $751

$1230 $1248 $1836 $1502 $1832

$1230 $1189 $957

$1228 $747

$985$1039 $788 $957

$1228 $897

$4777 $4862

NA $10619 $4044

$4777 $3300 $6189

$15060 $4275

$4777 $4743 $6640 $7357 $1760

$4777 $4619 $4676

$12225 $2898

$4777 $3756 $4765

$11494 $4119

$5808 $5912

NA $4463 $4916

$5808 $5100 $6118 $7868 $4730

$5808 $5894 $8088 $4463 $8651

$5808 $5616 $4947 $4463 $3588

$5808 $4517 $8627 $4463 $5009

$2589 $2634 $1873 $2048

$10900

$2589 $2000 $2185 $2048 $1976

$2589 $2627 $3855 $2879 $3855

$2589 $2502 $1873 $2048 $1570

$2589 $2014 $1803 $2048 $2232

$2364 $2406 $1616 $1536 $4500

$2364 $2364 $2490 $1536 $1925

$2364 $2398 $2647 $2887 $3521

$2364 $2286 $1616 $1536 $1428

$2364 $1838 $1616 $1536 $2039

$1094 $1114 $767

$1086 $3655

$1094 $1000 $1152 $1343 $1300

$1094 $1110 $1621 $1400 $1629

$903 $873 $767 $503 $548

$1094 $850 $767 $503 $943

$553 $562 $438 $660

$553 $500 $582 $700 $610

$553 $561 $824 $674 $824

$553 $534 $438 $512 $342

$553 $430 $438 $512 $477

$1136 $1157

NA $1045 $3700

$1136 $1000 $1446 $1045 $1099

$1136 $1153 $2068 $1388 $1692

$1136 $1099 $2951 $1045 $689

$1136 $752

$2450 $1045 $980

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

HCPCS Code

Insurer State

CO CT DC DE FL

$1191 $1052 $958 $498 $526

$1191 $1124 $1584 $498 $727

$1191 $600 $923 $592 $504

$1191 $1167 $923 $498 $708

$1191 $800 $958 $498 $686

$1487 $1314 $1112 $619 $661

$1487 $1403 $1156 $619 $908

$1487 $1200 $1112 $619 $531

$1487 $1457 $1112 $619 $885

$1487 $1000 $1156 $619 $857

$1885 $1663 $1318 $820 $831

$1885 $1778 $1318 $820

$1885 $1675 $1318 $820 $842

$1885 $1847 $1318 $820

$1885 $950

$1318 $820

$445 $393 $274 $377 $204

$445 $421 $269 $380 $272

$445 $200 $266 $380 $199

$444 $435 $269 $380 $289

$445 $327 $274 $380 $257

$360 $318 $464 $214 $357

$360 $339 $536 $404 $297

$360 $200 $214 $224 $280

$360 $353 $268 $214 $280

$360 $200 $357 $393 $287

$316 $279 $219 $197 $274

$316 $298 $423 $338 $261

$316 $100 $211 $267 $141

$316 NA

$314 $267 $209

$316 $250 $219 $285 $251

$4166 $3676 $3486 $5773 $1849

$4166 $3929 $3486 $5773 $2544

$4166 $2000 $3486 $4250 $1861

$4166 $4083 $3554 $5773 $2477

$4166 $3000 $3486 $5773 $2399

$728 $642 $602

$1303 $322

$728 $687 $602

$1303 $510

$728 $300 $579 $907 $325

$728 $713 $650

$1303 $519

$728 $500 $602

$1303 $419

$2121 $1872 $1665 $1971 $933

$2121 $2001 $1603 $1971 $1295

$2121 $1000 $1603 $1790 $948

$2121 $2079 $1665 $1971 $1261

$2121 $1500 $1603 $1971 $1221

$1917 $1693 $1503 $1638 $848

$1917 $1808 $1532 $1638 $1171

$1917 $900

$1503 $1618 $856

$1917 $1879 $1503 $1638 $1140

$1917 $1400 $1561 $1638 $1104

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

HCPCS Code

Insurer State

CO CT DC DE FL

$1366 $1207 $1102 $1235 $611

$1366 $1288 $1124 $1235 $834

$1366 $880

$1102 $1153 $610

$1366 $1339 $1102 $1235 $812

$1366 $950

$1102 $1235 $786

$912 $805 $751 $512 $407

$912 $860 $751 $512 $557

$912 $400 $751 $453 $407

$912 $894 $751

$2489 $650

$912 $500 $780 $512 $525

$1230 $1086 $957

$1228 $543

$1230 $1160 $1660 $1228 $751

$1230 $1200 $957

$1038 $549

$1230 $1205 $976

$3987 $732

$1230 $850 $995

$1228 $708

$4589 $4094 $4765 $5204 $3199

$4777 $4506

NA $14200 $2917

$4777 $4681 $4676 $4032 $2634

$4777 $4681

NA $4032 $3403

$4777 NA

$4587 $14058 $4275

$5808 $5127 $4527 $4463 $2561

$5808 $5479

$36590 $4463 $3547

$5808 $2700 $4527 $4902 $3172

$5808 $5692 $4615

NA $3454

$5808 $4050 $4703 $4463 $3345

$2589 $2285 $1803 $2048 $1136

$2589 $2442 $1803 $2048 $1580

$2589 $3000 $1803 $2048 $1157

$2589 $2537 $1873 $2048 $1539

$2589 $2150 $1803 $2048 $1491

$2364 $2087 $1555 $1536 $1052

$2364 $2230 $1555 $1536 $1444

$2364 $1392 $1616 $1536 $1025

$2364 $2317 $1586 $1536 $1406

$2364 $1750 $1555 $1536 $1361

$994 $877 $767 $503 $441

$1094 $1032 $1303 $503 $869

$1094 $530 $738 $543 $652

$1094 $1072 $753 $503 $710

$1094 $800 $767 $503 $652

$553 $488 $582 $442 $373

$553 $522 $438 $512 $438

$553 $300 $422 $467 $329

$553 $542 $438 $512 $393

$553 $350 $438 $531 $438

$1136 $1003 $2750 $1045 $509

$1136 $1072 $2250 $1045 $694

$1136 $600

$2616 $1045 $1015

$1136 $1113 $1700 $959 $737

$1136 $800

$2450 $1045 $654

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

HCPCS Code

Insurer State

GA HI IA ID IL

$1191 $1065 $1255 $498

$1191 $1170 $940

$1293 $1610

$1191 $1131 $1231 $2584 $1450

$1191 $1183 $1361 $1312 $1333

$1191 $828

$1085 $728 $450

$1487 $1329 $1156 $619

$1487 $1461 $2247 $1630 $2010

$1487 $1413 $1156 $3060 $1800

$1487 $1477 $1635 $1246 $1832

$1487 $1036 $1477 $900

$1885 $1685 $1369 $820

$1885 $1851 $1369 $2050 $3583

$1885 $1791 $1369 $3332 $2300

$1596 $1585 $1930 $1872 $1966

$1885 $622

$1369 $820

$445 $399 $470 $580 $465

$445 $437

NA $497 $600

$445 $423 $476 $787 $550

$445 $443 $687 $797 $549

$445 $286 $443 $426 $450

$360 $321 $659 $533 $393

$360 $354 $452 $247 $461

$360 $342 $393 $724 $450

$360 $357 $553 $644 $443

$360 $260 $428 $389 $300

$316 $283 $524 $533 $322

$316 $310

NA $188 $386

$316 $300 $385 $558 $400

$316 $314 $386 $565 $390

$316 $218 $219 $302 $322

$4166 $3722 $3621 $5773 $3309

$4166 $4091 $6990 $5773 $5625

$4166 $3958 $4330 $6041 $5100

$4166 $4136 $5611 $5773 $5130

$4166 $886

$3621 $5773 $3000

$728 $651 $602

$1303 $741

$728 $715

$728 $692 $761

$1303 $900

$728 $723 $904

$1303 $897

$728 $466 $579

$1303 $672

$2121 $1895 $1665 $1971 $1871

$2121 $2083

$2121 $2015 $2184 $2860 $2600

$2121 $2106 $3140 $1971 $2612

$2121 $1200 $2106 $1971 $1500

$1917 $1713 $1561 $1638 $1691

$1609 $1581

$1917 $1821 $1986 $3389 $2300

$1917 $1903 $2379 $1638 $2361

$1917 $716

$2056 $1638 $1400

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

HCPCS Code

Insurer State

GA HI IA ID IL

$1366 $1220 $1145 $1235 $1390

$1366 $1342 $1145 $1507 $1845

$1366 $1298 $1430 $2416 $1650

$984 $977

$1439 $1466 $1212

$1366 $630

$1145 $1235 $1300

$912 $815 $780 $512 $724

$912 $895

$912 $866 $867

$1611 $1100

$912 $905 $815 $512

$912 $638 $912 $547 $600

$1230 $1099 $995

$1228 $1085

$1230 $1208

$1060 $1007 $1133 $1876 $1300

$1230 $1221

NA $1228 $1353

$1230 $856

$1230 $1228 $900

$4777 $4269 $5100

$11739 $4275

$4777 $2846

$4777 $4538 $4964

NA $5800

$4777 $4743 $8500

NA $5883

$3991 $1486

NA $14200

$5808 $5190 $4703 $4463 $4538

$5808 $5704

$5808 $5518 $5594 $7072 $7100

$5808 $5767 $7094 $4827 $6562

$5808 $3112 $4527 $4827 $4100

$2589 $2313 $1873 $2048 $2570

$2589 $2542 $1873 $2879 $3495

$2589 $2460 $1873 $4246 $3200

$2589 $2570 $2914 $2685 $3187

$2589 $1320 $1873 $2048 $1800

$2364 $2112 $1616 $1536 $2085

$2364 $2321 $3848 $2639 $3190

$2364 $2246 $2462 $4178 $2900

$2214 $2198 $2599 $1536 $2726

$2364 $1642 $1616 $1536 $1700

$1094 $977

$1307 $1400 $1086

$1094 $1074 $1791 $1194 $1475

$1094 $1039 $1152 $1933 $1350

$1094 $1086 $1337 $1235 $1348

$1094 $574

$1114 $806 $518

$553 $494 $821 $741 $587

$553 $543

$492 $467 $630

$1197 $600

$553 $549 $438 $900 $680

$553 $382 $562 $672 $450

$1136 $1015 $2450 $1045 $1002

$1136 $1116

NA $1142 $1535

$1136 $1079 $1192 $2400 $1400

$1136 $1128 $1748 $2028 $1400

$1136 $1050 $2100 $1045 $812

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

HCPCS Code

Insurer State

IN KS KY LA MA

$899 $883 $958 $498 $560

$1191 $1050 $923 $498

$943 $943 $958

$1200 $511

$1191 $961

$1255 $2223 $258

$1191 $883 $958 $498

$1465 $1439 $1112 $619 $912

$1487 $1248 $1156 $619

$1183 $1183 $1156 $619 $712

$1487 $1201 $1156 $1173 $1136

$1487 $1103 $1156 $619

$1885 $1851 $1318 $820

$1885 $1512 $1318 $820

$1602 $1602 $1369 $820 $751

$1682 $1234 $1369 $820

$1885 $1398 $1369 $820

$445 $437 $532 $400 $377

$445 $437 $274 $380 $694

$445 $445 $534 $476 $330

$445 $328 $487 $775 $522

$445 $331 $274 $443 $474

$360 $354 $432 $400 $303

$360 $301 $299 $396 $580

$339 $339 $421 $369 $215

$360 $264 $461 $673 $429

$360 $267 $593 $348 $357

$316 $310 $379 $300 $267

$316 $150 $266 $347 $694

$316 $316 $411 $426 $138

$316 $233 $358 $550 $377

$316 $234 $394 $306 $351

$4166 $4091 $3554 $5773 $2500

$4166 $1008 $3554 $5773 $4336

$3845 $3845 $3621 $5773 $1953

$4166 $3059 $3621 $5773 $3180

$4166 $3088 $3486 $5773 $4621

$728 $715 $602

$1061 $454

$728 $693 $602

$1303 $872

$728 $728 $767

$1013 $320

$728 $535 $602

$1303 $628

$728 $540 $602

$1303 $768

$2121 $2083 $1665 $1971 $1321

$2121 $2083 $1603 $1971 $2208

$2121 $2121 $1603 $1971 $1028

$2121 $1557 $1665 $1971 $1619

$2105 $1561 $1634 $2004 $2336

$1917 $1883 $1548 $1638 $1193

$1917 $1883 $1503 $1638 $1996

$1917 $1917 $1503 $1638 $912

$1917 $1407 $2179 $1638 $1463

$1917 $1421 $1503 $1638 $2020

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

HCPCS Code

Insurer State

IN KS KY LA MA

$1366 $1342 $1145 $1235 $850

$1366 $1341 $1145 $1235 $2708

$1366 $1366 $1145 $1235 $891

$1366 $1003 $1145 $1235 $1043

$1366 $1013 $1145 $1235 $1440

$912 $895 $780 $512 $568

$912 $520 $751 $512 $949

$912 $912 $840 $512 $411

$755 $554 $930 $512 $576

$912 $676 $751 $512 $997

$1230 $1208 $995

$1228 $766

$1230 $1218 $957

$1228 $1534

$1230 $1230 $957

$1350 $577

$1230 $904

$1404 $1228 $1230

$1230 $912 $976

$1228 $1306

$4085 $4056 $4765

$14200 $2543

$4337$4777 $2310 $4587

$14910 $3807

$4777 $4777 $5347

$13660 $2245

$4777 $3897 $6843

$10080 $1600

$4777 $3542 $4765 $4550 $4970

$5808 $5704 $5808 $4463 $3485

$5808 $2310 $4527 $4463

$11676

$5808 $5808 $4527 $4463 $2837

$5808 $4265 $4703 $4463 $4107

$5808 $4306 $4527 $4463 $6122

$2589 $2542 $1803 $2048 $2185

$2589 $2161 $1873 $2048 $5119

$2589 $2589 $1873 $2048 $1200

$2589 $1900 $1873 $2048 $1976

$2589 $1919 $1873 $2048 $2872

$2364 $2321 $1555 $1536 $1472

$2364 $1575 $1616 $1536 $2700

$2364 $2364 $2490 $1536 $1132

$2364 $1736 $1616 $2300 $1805

$2364 $1753 $1616 $1536 $2577

$1094 $1074 $767 $503 $760

$654$1094 $500 $767 $503 $955

$1094 $1094 $1358 $1114 $518

$1094 $803

$1238 $2041 $1152

$1094 $811 $767 $800

$553 $543 $422 $618 $344

$553 $525 $438 $608

$553 $553 $686 $562 $431

$553 $407 $637

$1032 $379

$553 $410 $438 $567 $584

$1136 $1116 $2450 $1045 $795

$1136 $1050 $2450 $1045 $2168

$1136 $1136 $2450 $1045 $854

$1136 $834

$2450 $1045 $868

$1136 $842

$2000 $1072 $1260

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

HCPCS Code

Insurer State

MD ME MI MN MO

$1191 $901 $923 $498 $930

$1191 $702 $958 $809

$1191 $931 $941 $498 $868

$1191 $1191 $2486 $3330 $1394

$1191 $1112 $958 $498

$1487 $1125 $1112 $619 $976

$1487 $876

$1958 $619

$1465 $1143 $1156 $619

$1487 $1487 $2932 $4140 $1741

$1487 $1373 $1156 $619

$1717 $1298 $1318 $820

$1885 $1710 $2527 $820

$1798 $1253 $1369 $820

$1885 $1885 $4350 $5220 $2207

$1885 $1761 $1369 $820

$445 $338 $264 $380 $292

$445 $342 $642 $590 $481

$445 $264 $274 $497 $292

$445 $445

$1395 $1418 $640

$445 $417 $274 $380 $499

$360 $272 $550 $224 $280

$360 $342 $482 $403 $352

$360 $110 $650 $427 $373

$360 $360 $911 $571 $421

$294$360 $183 $428 $396 $336

$316 $239 $220 $267 $250

$316 $318 $424 $354 $309

$316 $110 $322 $350 $328

$316 $316

$1093 $900 $370

$294$316 $183 $333 $347 $329

$4166 $3150 $3486 $5773 $1861

$4166 $4136 $6656 $5773 $4204

$4166 $3253 $3621 $5773 $2730

$4166 $4166 $4388

$10545 $5978

$4166 $3890 $3486 $5773 $3339

$578 $419 $602

$1275 $482

$728 $540 $591

$1303 $714

$654 $342 $602

$1085 $429

$722 $722

$1940 $1303 $845

$728 $550 $602

$1303 $585

$2121 $1603 $1603 $1971 $1221

$2105 $1116 $1665 $1971 $2068

$2121 $1092 $1665 $2156 $1390

$2121 $2121 $3800 $1971 $3044

$2121 $1981 $1665 $1971 $1766

$1917 $1449 $1503 $1620 $1257

$1917 $1890 $2569

NA $1880

$1917 $1455 $1561 $1638 $1256

$1917 $1917 $5580 $4354 $2751

$1917 $1790 $1561 $1638 $1597

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

HCPCS Code

Insurer State

MD ME MI MN MO

$1310 $991

$1102 $1235 $896

$1366 $1125 $1831 $1235 $1365

$1366 $864

$1145 $1235 $895

$1366 $1366 $3520 $3780 $1599

$1366 $1275 $1102 $1235 $1356

$912 $690 $751 $512 $407

$912 $540 $780

NA $860

$912 $396 $780 $512 $598

$912 $912

$2160 $2837 $1308

$912 $851 $780 $512 $759

$1230 $893 $957

$1038 $806

$1230 $647 $995

NA $1206

$1213 $636 $957

$1228 $796

$1230 $1230 $2124 $3420 $1765

$1230 $770 $995

$1228 $986

$4777 $3612 $4899 $9046 $4275

$4777 $2134 $6375

NA $5185

$4777 $3770 $7225

NA $3130

$4777 $4777

NA $17460 $5591

$3927$4337 $3899 $4587

$14875 $4275

$5808 $4392 $4527 $4463 $3810

$5808 $5265 $8072

NA $5858

$5808 $4535 $4615 $4463 $3806

$5808 $5808 $6118

$23091 $8336

$5808 $5115 $4675 $4463 $6046

$2589 $1958 $1873 $2048 $1698

$2589 $2542 $3476 $2048 $2611

$2589 $1942 $1873 $2048 $1696

$2589 $2589 $4700

$13518 $3000

$2589 $2417 $1873 $2048 $2156

$2364 $1788 $1616 $1536 $1551

$2364 $2052 $3168 $1536 $2384

$2364 $827

$1616 $1536 $1549

$2364 $2364 $6200 $6570 $2767

$2364 $2208 $1616 $1536 $2208

$1094 $828 $767 $503 $717

$1094 $1074 $1466 $713

$1093 $496

$1152 $1056 $812

$1094 $1094 $2245 $3438 $1571

$1094 $1022 $767

$1173 $1200

$530 $400 $438 $512 $363

$553 $459 $741 $618 $558

$553 $364 $566 $615 $553

$553 $553

$1263 $1757 $646

$553 $385 $438 $608 $600

$1136 $859

$2616 $959

$1136 $598

$2000 $1238 $1243

$1136 $442

$2138 $1045 $745

$1136 $1136 $1811 $3150 $1631

$984$1136 $977

$2450 $1045 $911

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

HCPCS Code

Insurer State

MS MT NC ND NE

$1191 $1091 $1735 $3200 $3100

$1191 $1191 $2123 $2484 $1818

$1128 $1019 $1255 $756 $728

$1191 $1212 $5211 $2129 $2586

$1191 $1191 $1801 $2582 $2060

$1487 $1363 $2169 $2500 $4700

$1487 $1486 $2932 $3102 $2271

$1189 $1074 $1298 $619 $535

$1487 $1514 $3518 $3690 $3231

$1487 $1487 $2217 $2880 $2574

$1885 $1727 $1900 $2100 $4200

$1885 $1885 $4350 $3297 $2879

$1885 $1704 $1872 $820 $848

$1717 $1748 $8108 $4685 $3730

$1885 $1885 $2762 $3400 $3262

$445 $409

$1100 $1100 $1000

$445 $445

$1163 $930 $681

$445 $403 $365 $402 $614

$445 $454

$2591 $1385 $969

$445 $445 $633 $680 $772

$360 $329 $900 $900 $988

$360 $360 $600 $768 $549

$360 $325 $765 $365 $536

$360 $366 $911

$1100 $781

$360 $360 $578 $780 $642

$316 $290 $645 $911 $768

$316 $316 $911 $440 $483

$316 $286 $486 $365 $471

$316 $322

NA $810 $687

$316 $316 $520 $686 $567

$4166 $3816 $9000 $9300 $8500

$4166 $4165

$10500 $8023 $6360

$4166 $3764 $4136 $5773 $1861

$4166 $4240

NA $10745 $10000

$4166 $4166 $5873 $8300 $7208

$654 $599 $767

$1600 $1400

$728 $727

$1617 $1600 $1112

$728 $658 $723

$1013 $470

$728 $741

$1617 $1980 $1581

$728 $728 $675

$1303 $1260

$2121 $1943 $2633 $4700 $4500

$2121 $2121 $3370 $3400 $3239

$2121 $1916 $2106 $2317 $948

$2121 $2159 $4500 $5300 $4608

$2121 $2121 $3190 $3186 $3670

$1917 $1756 $1561 $3700 $4100

$1917 $1917 $4650 $1638 $2927

$1917 $1732 $2019 $1638 $856

$1917 $1951 $4650 $1903 $4163

$1917 $1917 $2219 $4000 $3317

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

HCPCS Code

Insurer State

MS MT NC ND NE

$1366 $1251 $1145 $2600 $2900

$1366 $1366 $2933 $2900 $2085

$1366 $1234 $1342 $1235 $896

$1366 $1390 $5923 $3240 $2966

$1366 $1366 $2184 $2500 $2363

$912 $835

$1625 $1347 $1900

$610 $610

NA $512 $932

$912 $824 $960 $512 $407

$912 $928

$1800 $2160 $1981

$912 $912 $815 $512

$1230 $1127 $3100 $1228 $2800

$763 $763

NA $1228 $1166

$1230 $1111 $1295 $1221 $549

$1230 $1252 $1770 $1221 $2672

$1230 $1231 $1423 $1228 $2128

$4777 $4376 $5032

$11799 $4275

$4777 $4777

$4777 $4316 $5600 $6653 $4275

$4777 $4862

$10583

$4777 $4777

NA $9886 $8265

$5808 $5321 $4527

$13600 $13900

$5808 $5808

$5808 $5248 $6118 $4325 $3172

$5808 $5912

$12868

$5808 $5808 $5190

$12603 $10050

$2212 $2026 $2185 $4900 $5000

$2589 $2589 $3825 $4500 $3951

$2589 $2339 $2570 $2048 $1236

$2589 $2634 $8080 $5940 $5621

$2589 $2589 $3919 $4706 $4478

$2289 $2097 $2243 $4700 $4600

$2364 $2364 $5250 $5100 $3609

$2293 $2072 $2490 $1536 $1032

$2364 $2406 $5250 $6115 $5135

$2364 $2364 $2691 $3873 $4090

$1094 $1003 $2100 $2500 $2100

$1094 $1093 $1871 $2281 $1671

$1094 $988

$1152 $1029 $968

$1094 $1114 $2245 $3105 $2377

$654 $654

$1742 $1419 $1132

$553 $506

$1300 $1300 $1400

$553 $553 $878 $890 $843

$553 $500 $676 $543 $562

$553 $562

$4888 $1530 $1199

$553 $553 $924

$1197 $955

$1136 $1041 $2100 $2100 $2300

$1136 $1135 $2800 $1128 $1736

$1136 $1026 $1906 $846

$1136 $1157 $2528 $8645 $2469

$1136 $1136 $1641 $2000 $1967

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

HCPCS Code

Insurer State

NH NJ NM NV NY

$1191 $727 $923 $498

$1191 $953 $930 $498

$1191 $1191 $1010 $2516 $831

$1191 $592 $941 $498 $568

$899$1128 $725 $958 $498 $685

$1487 $908

$1112 $619

$1345 $1076 $1112 $619

$1487 $1487 $1112 $3141 $1514

$1487 $739

$1112 $619 $885

$1345$1487 $1000 $1156 $619 $848

$1885 $1151 $1318 $820

$1885 $1508 $1318 $820

$1727 $1727 $1318 $3649 $1459

$1885 $936

$1318 $820

$1885 $604

$1369 $820

$445 $272 $264 $527 $427

$445 $356 $264 $380 $374

$445 $445 $476 $940 $377

$445 $222 $264 $380 $265

$445 $400 $264 $380 $278

$360 $220 $552 $403 $357

$360 $288 $400 $374 $321

$360 $360 $536 $761 $366

$360 $179 $250 $266 $167

$360 $200 $500 $996 $252

$251 $153 $349 $285 $240

$316 $253 $211 $285 $270

$316 $316 $219 $609 $322

$316 $158 $211 $285 $150

$316 $200 $220 $361 $251

$4166 $2544 $3486 $5773 $4621

$4166 $3333 $3486 $5773 $3499

$4166 $4166 $3486 $8796 $2909

$4124 $2047 $4388 $5773 $1938

$4085$4166 $3660 $3486 $5773 $2593

$728 $445 $579

$1303 $697

$728 $582 $579

$1303 $622

$707 $707 $602

$1492 $494

$728 $362 $579

$1303 $433

$615$728 $503 $579

$1303 $454

$1689 $1031 $1603 $1971 $1569

$2121 $1697 $1665 $1971 $1782

$2121 $2121 $1603 $4478 $1481

$2121 $1053 $1603 $1971 $1262

$2067$2121 $1250 $1603 $1971 $1321

$1917 $1171 $1503 $1638 $1420

$1917 $1534 $1507 $1638 $1610

$1917 $1917 $2093 $4048 $1338

$1917 $952

$1503 $1638 $1140

$1917 $1475 $1534 $1638 $1193

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

HCPCS Code

Insurer State

NH NJ NM NV NY

$1366 $834

$1102 $1235 $1420

$1366 $1093 $1102 $1235 $1147

$1366 $1366 $1102 $1700 $1154

$1366 $679

$1102 $1235 $812

$1366 $1064 $1145 $1235 $850

$912 $557 $751 $512 $924

$912 $730 $751 $512 $650

$912 $912 $840

$1924 $637

$802 $399 $751 $512 $542

$912 $503 $751 $512 $568

$1230 $751 $957

$1213 $876

$1230 $984 $981

$1228 $1033

$1230 $1230 $957

$3145 $859

$985 $489 $957

$1228 $732

$1230 $503 $995

$1228 $766

$4777 $2917

$4777 $3822 $4743

$14930 $4275

$4777 $4777

NA $12155 $3046

$4777 $2372 $4676

$16491 $2841

$4412$4777 $3407 $4587 $5838 $3403

$5808 $3547 $4527 $4463 $5283

$5808 $4646 $4527 $4463 $4879

$5808 $5808 $4527

$14790 $4907

$5808 $2884 $4527 $4463 $3454

$5808 $5232 $4703 $4463 $3616

$2043 $1247 $1803 $2048 $2831

$2589 $2071 $1803 $2048 $2175

$2589 $2589 $1803 $5465 $1807

$2589 $1286 $1803 $2048 $1539

$2589 $2435 $1873 $2048 $1611

$2364 $1444 $1555 $1536 $2585

$2364 $1891 $1616 $1536 $1986

$2364 $2364 $1555 $4990 $1997

$2364 $1174 $1555 $1536 $1406

$2364 $900

$1616 $1536 $1608

$1094 $668 $767 $503

$1094 $875 $767 $503 $936

$1094 $1094 $767

$2309 $1114

$1094 $543 $760 $503 $537

$1088$1094 $317 $860

$1097 $806

$553 $337 $438 $565 $559

$553 $442 $438 $512 $472

$553 $553 $574 $935 $562

$553 $275 $422 $512 $268

$553 $391 $438 $556 $347

$903 $551

$2000 $1500 $1243

$1136 $909

$2248 $1045 $954

$1125 $1125 $2750 $1615 $785

$1136 $564

$2450 $1045 $675

$1136 $815

$2248 $1045 $707

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

HCPCS Code

Insurer State

OH OK OR PA RI

$1033 $847 $923 $498 $347

$1191 $1095 $923 $498

$1191 $897

$1301 $1745 $1420

$1191 $936 $923 $498 $848

$1191 $710

NA $498

$1487 $1417 $1112 $619 $500

$1487 $1367 $1112 $619

$1487 $1120 $1514 $2180 $1817

$1487 $1169 $1112 $619

$1487 $886

NA $619

$1789 $1704 $1318 $820 $602

$1885 $1733 $1369 $820

$1885 $1420 $1930 $2763 $2303

$1885 $1400 $1318 $820

$1885 $1123

NA $820

$445 $424 $264 $380 $390

$445 $409 $434 $278 $620

$445 $336 $930 $681 $545

$445 $437 $274 $380 $318

$445 $266

NA $380 $463

$332 $316 $236 $226 $277

$330 $303 $334 $214 $459

$360 $271 $510 $527 $439

$360 $357 $411 $439 $256

$360 $214

NA $399 $357

$316 $301 $187 $174 $106

$316 $290 $291 $188 $440

$316 $238 $367 $464 $386

$316 $310 $219 $285 $225

$269 $160

NA $285 $267

$4166 $3968 $3486 $5773 $1400

$4166 $3829 $3621 $5773 $5790

$3377 $2543 $3621 $5773 $3437

$4166 $4091 $3486 $5773 $2968

$4166 $2482

NA $5773 $4322

$728 $694 $579 $677 $245

$728 $669 $579 $615

$728 $548 $795

$1265 $741

$728 $715 $579

$1303 $519

$728 $434

NA $1035 $723

$2121 $2021 $1603 $1971 $713

$2121 $1949 $1603 $1971 $2948

$2121 $1598 $1665 $2912 $2159

$2121 $1300 $1603 $1971 $1511

$2121 $1264

NA $1971 $2201

$1917 $1827 $1503 $1638 $644

$1917 $1762 $1503 $1638 $2664

$1231 $927

$1503 $1788 $1253

$1917 $1200 $1561 $1638 $1366

$1917 $1142

NA $2919 $1989

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

HCPCS Code

Insurer State

OH OK OR PA RI

$1366 $1302 $1102 $1235 $900

$1216 $1118 $1102 $1235 $1691

$1366 $1029 $1305 $2002 $1668

$1366 $700

$1102 $1235 $973

$1231 $733

NA $1235 $1277

$912 $868 $751 $512 $306

$784 $721 $751 $512

$912 $687 $780 $912 $928

$912 $845 $780 $512 $650

$912 $543

NA $1006 $946

$1230 $1172 $957

$1228 $413

$1230 $1131 $957

$1228 $1832

$1230 $926 $995

$1228 $1252

$1230 $500 $995

$1228 $876

$1230 $733

NA $1614 $1277

$4777 $4601 $4587 $6555 $1606

$4777 $4391 $4587

$14200 $5700

$4777 $3598 $5692

$14028 $4862

$4777 $3794 $4587

$15660 $3403

$4777 $2846

$5808 $5704 $4527 $4463 $1953

$5808 $5338 $4527 $4099 $8074

$5808 $4375 $4703 $4463 $5912

$5808 $4250 $4703 $4463 $4138

$5808 $3460

$2589 $2466 $1803 $2048 $870

$2589 $2380 $1803 $2048 $3598

$2589 $1949 $2726 $3708 $2634

$2589 $2436 $1803 $2048 $1844

$2580 $1537

NA $2048 $2677

$2364 $2251 $1555 $1536 $795

$2364 $2173 $1565 $1536 $3286

$2364 $1780 $2490 $3368 $2816

$2364 $2321 $1555 $1536 $1684

$2364 $1408

NA $1536 $2453

$1094 $1042 $738 $503 $368

$1094 $1006 $738 $503

$1094 $824

$1195 $1604 $1337

$1094 $600 $767 $503 $780

$1094 $652

NA $819

$553 $527 $422 $411 $513

$553 $508 $422 $512 $769

$553 $416 $604 $809 $674

$553 $400 $422 $512 $393

$553 $329

NA $512 $574

$1136 $1083 $1080 $846

$1136 $1044 $2450 $959

$1136 $856

$1400 $1045 $1157

$1136 $800

$2450 $1045 $810

$734 $437

NA $1238 $761

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

HCPCS Code

Insurer State

SC SD TN TX UT

$1191 $1063 $1183 $756

$1191 $1170 $1301 $3040 $1450

$971 NA

$970 $1908 $988

$1191 $1164 $958 $849 $550

$1191 $720 $958 $519

$1345 $1201 $1156 $619

$1487 $1461 $2068 $2880 $1800

$1213 NA

$1156 $2049 $1235

$1487 $1453 $1156 $619 $880

$1487 $899

$1156 $619

$1379 $1231 $1369 $820

$1885 $1851 $2621 $4845 $2300

$1885 NA

$1369 $2900 $1919

$1885 $1842 $1369 $820

$1885 $1897 $1369 $820

$444 $396 $274 $452 $500

$445 $437

$1473 $2070 $550

$445 NA

$696 $1093 $454

$445 $436 $274 $399 $336

$445 $430 $358 $278 $454

$360 $322 $446 $357 $550

$360 $354 $449 $607 $450

$360 NA

$673 $915 $366

$360 $351 $439 $450 $238

$360 $348 $275 $224 $366

$316 $282 $314 $347 $300

$316 $310 $450 $832 $400

$316 NA

$494 $620 $322

$316 $309 $300 $314 $209

$316 $306 $242 $197 $322

$4166 $3717 $3621 $5801 $3000

$4166 $4091 $4388 $9393 $5100

$4166 NA

$3621 $5950 $2968

$3824 $3736 $3621 $5773 $2296

$4166 $4037 $3486 $5773 $4240

$728 $650 $602

$1014 $628

$728 $715 $755

NA $900

$728 NA

$615 $1430 $741

$728 $711 $602

$1303 $431

$578 $463 $602

$1085 $588

$2121 $1893 $1603 $2000 $2000

$2121 $2083 $6997 $4770 $2600

$2121 NA

$1665 $2800 $2159

$2121 $2073 $1665 $1971 $1255

$2121 $2055 $1603 $1971 $2159

$1917 $1711 $1503 $1638 $950

$1917 $1883 $3143 $2124 $2300

$1917 NA

$2019 $3000 $1951

$1917 $1873 $1561 $1638 $1134

$1917 $1859 $1507 $1638 $1951

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

HCPCS Code

Insurer State

SC SD TN TX UT

$1366 $1219 $1145 $1235 $1200

$1310 $1218 $2025 $3420 $1600

$1366 NA

$1145 $2281 $1390

$1366 $1334 $1145 $1235 $808

$1366 $1323 $1102 $595

$912 $814 $751 $512 $435

$873 $812 $900

$1710 $1050

$912 NA

$780 $1400 $912

$912 $891 $780 $512 $548

$912 $786 $751 $512 $928

$1230 $1098 $957

$1228 $549

$1202 $1118 $885

$2660 $1450

$1230 NA

$1038 $2000 $876

$1230 $1202 $995

$1228 $739

$1230 $1260 $995

$1038 $1252

$4777 $4262 $4587 $4445 $4275

$4777 $4743

NA $9249 $5800

$4777 NA

$5100 $9800 $4275

$4777 $4668 $4587

$14200 $550

$4777 NA

$4765 NA

$5808 $5183 $4527 $4463 $3749

$5808 $5704 $4044

$11700 $7100

$5808 NA

$4615 $7080 $4138

$5808 $5676 $4703 $4463 $3435

$5808 $5629 $4527 $2531 $5912

$2589 $2309 $1873 $2048 $3000

$2589 $2542 $3598 $5679 $3200

$2589 NA

$1873 $4345 $2634

$2589 $2529 $1873 $2048 $1554

$2589 $2570 $1873 $2048 $2634

$2364 $2110 $1616 $1536 $1503

$2364 $2321 $3286 $4860 $2900

$2364 NA

$1616 $3600 $2406

$2364 $2310 $1616 $1536 $1398

$2364 $2291 $1586 $1536 $2406

$1043 $931

$1036 $1036 $977

$1094 $1074 $1740 $2608 $1350

$1094 NA

$1711 $2148 $1114

$1094 $1069 $977 $977 $657

$744 $666 $738 $477 $757

$553 $494 $549 $549 $600

$553 $543 $769

$2363 $650

$553 NA

$844 $933 $562

$553 $540 $566 $600 $550

$553 $537 $434 $344 $562

$1136 $1014 $2450 $1045 $1004

$1136 $1116 $1195 $2805 $1400

$1136 NA

$2450 $1045 $1004

$1136 $1111 $2450 $1045 $672

$1136 $922

$1650 $959

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1191 $1112 $923 $498 $930

$1191 $1917

$899 $695

$1107 $893 $854

$1191 $1182 $7480 $7480 $1394

$1191 $1072 $1515 $498

$1082 $967

$16575 $498

$1487 $1388 $1112 $619 $976

$1487 $1446 $1034 $1125 $2397

$1201 $929

$1311 $1192 $1192

$1487 $1477 $5820 $5625 $1741

$1487 $1338 $1438 $619

$1487 $1329 $1514 $619

$1885 $1758 $1318 $820

$1545 $1499 $1074 $1435 $2933

$1885 $1458 $1872 $1872 $1885

$1885 $1870 $7446 $9945 $3032

$1885 $1697 $1369 $820

$1567 $1400 $1951 $820

$445 $376 $266 $380 $350

$445 $427

$1974 NA

$445 $345 $470 $463 $443

$445 $441

$2805 $3220 $522

$445 $401 $443 $380 $540

$360 $324 $366 $554 $800

$360 $336 $214 $214 $315

$251 $244 $338 $393 $685

$360 $278 $600 $357 $360

$360 $357 $765

$1380 $403

$331 $298 $329 $611 $450

$289 $258

$1710 $1000 $1000

$316 $295 $219 $267 $270

$249 $235 $640

NA $680

$316 $245 $377 $318 $316

$316 $313 $972

$2380 $384

$316 $284 $333 $574 $405

$289 $260 $253

$1132 $400

$4166 $3567 $3486 $5773 $1861

$4166 $4052

NA $5773 $4621

$4166 $3222 $3688 $5700 $3958

$4166 $4132 $3621

$10545 $4240

$4166 $3749 $4388 $5773 $5175

$4166 $3722

NA $5773 $5300

$728 $679 $579 $615 $570

$728 $706 $647 $767 $822

$728 $563 $850

$1013 $692

$728 $722

$1085 $2530 $887

$728 $655 $602

$1303 $900

$728 $651 $602

NA $910

$2121 $1979 $1665 $1971 $948

$1467 $1421 $1603 $1971 $2203

$2121 $1641 $2159 $2106 $2015

$2121 $2104 $1958 $7160 $2375

$2121 $1909 $2106 $1971 $2610

$1609 $1438 $8100

NA $2159

$1917 $1789 $1561 $1638 $1257

$1917 $1865

$1917 $1483 $2019 $1903 $1821

$1917 $1902 $5257

$14060 $4286

$1917 $1725 $1917 $2179 $2385

$1917 $1713 $1986 $1620 $2927

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

HCPCS Code

Insurer State

VA VT WA WI WV WY

$1366 $1275 $1102 $1235 $1050

$1366 $1325 $1102 $3500 $2053

$1366 $1056 $1400 $1356 $1366

$1366 $1355 $3273 $6375 $1663

$1366 $1229 $1380 $1235 $1710

$1069 $955

$1238 $1235 $1800

$912 $850 $780 $512 $597

$912 $880

$912 $705 $780 $905 $866

$912 $904

$2400 $3796 $1067

$912 $821 $897 $512

$912 $815

NA $210 $932

$1230 $1148 $995

$1038 $806

$1230 $1194

$1230 $952 $995

$1228 $1169

$1230 $1220 $2850 $5700 $1440

$1230 $1107 $1230 $1600 $1530

$1230 $1099

NA $945

$4777 $4506 $4587 $8773 $4275

$4777 $2614

NA NA NA

$4777 $3695 $6755 $4956 $4538

$4777 $4743

$18024 $12288 $5229

$4777 $4299 $5032

$17680 $4403

$4777 $4269

$5808 $5419 $6118 $4463 $3172

$5808 $5647

$5808 $4493 $6635 $5767 $5518

$5808 $5761 $4947

$26315 $5912

$5808 $5227 $5808 $9500 $7200

$5808 $5190

NA $4463 $7390

$2589 $2328 $1803 $2048 $1698

$2589 $2092

NA $2879 $3889

$2589 $2002 $2726 $2570 $2460

$2589 $2567 $7752

$11475 $3951

$2589 $2330 $1873 $2048 $3195

$2589 $2313 $2634 $5400 $4000

$2364 $2205 $1616 $1536 $1551

$2364 $2292 $2697 $2639 $2934

$2356 $1822 $2490 $2181 $2238

$2364 $2344 $9350

$10540 $2878

$2364 $2128 $2193 $1536 $2925

$2309 $2064 $2875 $1536 $3609

$1094 $1000 $767 $503 $850

$1094 $1063 $760

$1086 $1643

$1094 $847

$1210 $1086 $1094

$1094 $1085 $5270 $6035 $1281

$1094 $985

$1119 $503

$1094 $985

$1362 $1878 $2400

$553 $516 $422 $467 $495

$553 $532 $718

$2253 $830

$553 $427 $593 $600 $553

$553 $548

$2522 $5700 $646

$553 $498 $549 $815 $675

$447 $400

$1822 $1776 $800

$1136 $950

$2616 $959

$812 $784

$2856 NA

$1136 $879

$2070 $1128 $1079

$1136 $1127 $5950 $5850 $1331

$1136 $1022 $1249 $1045 $1395

$529 $476 $868

$1045 $825

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

8870790 $87715544 7537056 $36412622 42

27406336 $315878919 24785107 $130632849 41

80061 Lipid panel 20620917 $300263670 18497996 $125993031 42

6804619 $30263393 6406217 $9801294 32

4312499 $15380015 4045779 $4427415 29

5078609 $16012775 4673129 $4383224 27

4649643 $33541369 4616456 $10457972 31

82607 Vitamin B-12 3363543 $71298574 3329444 $25252596 35

12678817 $172653909 12377783 $51406983 30

83540 Assay of iron 2625017 $23249999 2511258 $10256188 44

1154872 $67030516 1143748 $22934465 34

3616338 $93492483 3545187 $32784887 35

14761102 $348014395 14465072 $140148947 40

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

HCPCS Code

Description

2011 Number of

Allowed Tests

2011 Medicare-

Allowed Amount

Number of Tests

With Potential

for Savings

Amount of Potential

Savings to Medicare

Medicare

30827609 $333380573 29163289 $136848356 41

4703518 $53236384 4642330 $15296087 29

Total 182683885 $2416399964 171409646 $909884674 38

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

APR 2 6 2013DATE

CMS Response

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

cover13

executive summary13

table of contents13

objectives13

background13

methodology13

findings13

appendix a13

appendix b13

appendix c13

appendix d13

acknowledgments13

inside cover13

Documents

HHS Office of Inspector General report - oig.hhs.govoig.hhs.gov/oei/reports/oei-07-11-00010.pdf · Agency Comments and Office of Inspector General Response ... lowest insurer’s