Liver Transplant Billing

The following is an itemized list of all paid billing charges for a patient who received chemotherapy in 2016 then radio frequency ablation therapy and a liver transplant in 2017 for a diagnosis of liver cancer. For each year from 2016-2018, all paid medical services the patient received for any reason are listed as well as the billing codes that were paid, total charges for each approved service and the amounts paid by both Medicare and non-Medicare payers. The providers in each case are the doctors or other medical providers who were paid for each service. The numerical code for each provider is listed at the bottom of each table.

Medical Services in 2016

2016 Data Table
List of Doctors

Date Code* Service Charge* Medicare
Payment		 Ded/Co-ins. Provider**
1/20/2016 99204 Office Visit $526.00 $113.85 $29.04 5
2/8/2016 36415,
85025,
85610,
80053,
82248,
82105		 Blood Tests $316.20 $55.06 $0.00 18
2/9/2016 76937,
75726,
36247,
75774,
36248		 Arterial Catheter
Placement		 $2,036.00 $212.23 $54.14 16
2/9/2016 99220 Hospital Visit $558.00 $166.23 $42.41 6
2/9/2016 37243 Chemoembolization $2,036.00 $528.00 $134.83 16
2/10/2016 99217 Hospital Visit $260.00 $66.42 $16.94 16
2/10/2016 37243 Chemoembolization $116,884.19 $11,903.55 $1,288.00 18
2/17/2016 90837 Psychotherapy $190.00 $105.23 $26.85 14
2/17/2016 78306 Bone Density $252.00 $38.38 $9.79 16
2/17/2016 G0480 Drug Screen $106.00 $78.34 $0.00 18
2/18/2016 99205 Office Visit $653.00 $150.77 $38.46 17
2/18/2016 90792 Office Visit $600.00 $127.50 $32.53 13
2/18/2016 99204 Office Visit $526.00 150.87 38.49 2
2/18/2016 78452,
A9502,
J2785		 Nuclear Scan
of heart		 $3,275.00 $852.38 $217.44 2
2/18/2016 93306 Echocardiogram $753.00 $188.60 $48.11 2
2/24/2016 90837 Psychotherapy $190.00 $105.23 $26.85 14
2/25/2016 36415,
85025,
85610,
80053		 Blood Tests $172.03 $32.67 $0.00 18
3/2/2016 90837 Psychotherapy $190.00 $105.23 $26.85 14
3/3/2016 99213 Office Visit $110.00 $62.92 $16.05 8
3/4/2016 36415,
85025,
85610,
80053		 Blood Tests $172.03 $32.67 $0.00 18
3/9/2016 90837 Psychotherapy $190.00 $105.23 $26.85 14
3/10/2016 82105,
85025,
85610,
80053		 Blood Tests $313.72 $55.06 $0.00 18
3/15/2016 74183 MRI $5,548.34 $440.75 $159.57 18
3/15/2016 74183 MRI Reading $305.00 $102.84 $26.24 16
3/16/2016 90837 Psychotherapy $190.00 $105.23 $26.85 14
3/21/2016 99215 Office Visit $462.00 $97.75 $24.93 5
3/23/2016 90837 Psychotherapy $190.00 $105.23 $26.85 14
3/28/2016 G0202,
77052		 Mammogram $144.02 $40.87 $0.00 16
3/30/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
3/31/2016 Q0091 Pap Smear $195.00 $50.36 $0.00 10
3/31/2016 G0123 Pap Smear
Cytology		 $84.36 $27.05 $0.00 18
4/5/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
4/11/2016 82105,
36415,
85025,
85610,
80053		 Blood Tests $313.72 $55.06 $0.00 18
4/13/2016 90837 Psychotherapy $190.00 $105.23 $26.85 14
4/20/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
4/26/2016 99214 Office Visit $180.00 $90.52 $23.57 13
4/27/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
5/4/2016 90837 Psychotherapy $190.00 $105.23 $26.85 14
5/6/2016 45378 Sigmoidoscopy $689.00 $43.06 $10.98 5
5/6/2016 43239 Endoscopic Biopsy $1,756.00 $131.63 $33.58 5
5/6/2016 88305 Pathology Reading $300.00 $36.22 $9.24 11
5/11/2016 99212,
17000,
17003		 Office Visit
and Procedure		 $500.03 $134.74 $34.37 3
5/11/2016 90837 Psychotherapy $190.00 $105.23 $26.85 14
5/13/2016 G0479,
36415,
85025,
85610,
80053,
82105		 Blood Tests $536.17 $132.72 $0.00 18
5/13/2016 G0480 Drug Screen $114.65 $78.34 $0.00 18
5/18/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
5/25/2016 90837 Psychotherapy $190.00 $105.23 $26.85 14
6/1/2016 90837 Psychotherapy $190.00 $105.23 $26.85 14
6/6/2016 99214,
76881		 Office Visit
and Ultrasound		 $517.00 $202.24 $51.59 19
6/8/2016 90837 Psychotherapy $190.00 $105.23 $26.85 14
6/10/2016 82105,
36415,
85025,
85610,
80053		 Blood Tests $313.72 $55.06 $0.00 18
6/14/2016 74183 MRI $5,548.34 $440.75 $159.57 18
6/14/2016 74183 MRI Reading $305.00 $102.84 $26.24 16
6/15/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
6/21/2016 99215 Office Visit $462.00 $97.75 $24.93 5
6/22/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
6/28/2016 99214 Office Visit $180.00 $90.52 $23.57 13
6/29/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
6/30/2016 00810 Anesthesia $977.50 $199.34 $0.00 1
6/30/2016 45378 Colonoscpy $1,973.00 $219.65 $43.93 5
7/6/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
7/13/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
7/20/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
7/20/2016 82105,
86704,
36415,
85025,
85610,
80053		 Blood Tests $405.66 $71.14 $0.00 18
7/27/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
8/3/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
8/10/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
8/17/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
8/19/2016 82105 Blood Test $141.69 $22.39 $0.00 18
8/25/2016 99214,
90836		 Office Visit $330.02 $157.06 $40.89 13
9/7/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
9/14/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
9/15/2016 74183 MRI $5,548.34 $440.75 $159.57 18
9/15/2016 74183 MRI Reading $305.00 $102.84 $26.24 16
9/16/2016 36415,
85025,
85610,
80053,
82105		 Blood Tests $313.72 $55.06 $0.00 18
9/19/2016 36415,
85610		 Blood Tests $57.32 $8.19 $0.00 18
9/20/2016 G0463 Hospital Clinic $268.00 $112.71 $28.76 18
9/20/2016 99215 Office Visit $462.00 $97.75 $24.93 5
9/21/2016 99214 Office Visit $175.00 $96.18 $24.54
9/21/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
9/28/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
10/5/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
10/6/2016 99214 Office Visit $245.52 $92.37 $23.57 10
10/12/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
10/13/2016 76856,
76830		 Ultrasound Reading $292.00 $60.16 $15.35 16
10/19/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
10/20/2016 97001 Physical Therapy $231.50 $157.29 $40.13 12
10/24/2016 97110,
97140		 Physical Therapy $131.00 $86.10 $21.96 12
10/26/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
10/27/2016 97110,
97140,
G0283		 Physical Therapy $146.00 $94.94 $24.32 12
10/31-11/3/2016 97110,
97140,
G0283		 Physical Therapy x 2 $310.00 $202.05 $51.54 12
11/2/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
11/8/2016 92004,
92015		 Eye Exam $330.06 $192.94 $124.21
11/9/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
11/9/2016 97110,
97140,
G0283		 Physical Therapy $146.00 $94.94 $24.32 12
11/14/2016 97110,
97140,
G0283		 Physical Therapy $146.00 $94.94 $24.32 12
11/14/2016 97110,
97140		 Physical Therapy $164.00 $107.11 $27.32 12
11/16/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
11/16/2016 90662,
90732,
G0008,
G0009		 Flu and
Pneumococcal
Vaccines		 $220.00 $189.86 $0.00 8
11/17/2016 36415,
85025,
85610,
80053,
82105		 Blood Tests $313.72 $55.06 $0.00 18
11/21/2016 80053 Blood Test $172.03 $17.04 $0.00 18
11/29/2016 74183,
A9579		 MRI $5,114.46 $424.94 $206.02 18
11/29/2016 74183 MRI Reading $305.00 $102.84 $26.24 16
11/30/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
11/30/2016 97110,
97140		 Physical Therapy $131.00 $87.50 $22.32 12
12/7/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
12/7-12/19/2016 97110,
97140		 Physical Therapy x 3 $426.50 $280.71 $71.60 12
12/14/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
12/15/2016 99215 Office Visit $462.00 $126.20 $32.20 5
12/19/2016 G0283 Physical Therapy $15.00 $8.84 $2.26 12
12/21/2016 90834 Psychotherapy $180.00 $70.00 $17.86 14
12/27/2016 97110,
97140		 Physical Therapy $131.00 $86.10 $21.96 12
12/27/2016 36415,
85025,
85610,
80053,
82105		 Blood Tests $313.72 $55.06 $0.00 18
12/29/2016 97110,
97140		 Physical Therapy $131.00 $86.10 $21.96 12
Totals $176,518.78 $24,915.48 $4,563.07

*The codes listed are only the ones paid by any any payee. Codes that weren’t paid by any party aren’t listed, though all charges associated with an allowed service are included in total charges for that service (including charges for unpaid codes).

**Provider codes are as follows:
1-Anesthesia, 2-Cardiology, 3-Dermatology, 4-ER, 5-GI/Liver, 6-Hospitalist, 7-Infectious Disease, 8-Internal Medicine, 9-Interventional Radiology, 10-OB/Gyn, 11-Pathology, 12-Physical Therapy, 13-Psychiatry, 14-Psychologist, 15-Pulmonary, 16-Radiology, 17-Surgeon, 18-Hospital/Lab, 19-Pharmacy, 20-Orthopedics

Medical Services in 2017

2017 Data Table
List of Doctors

Date Code* Service Charge* Medicare
Payment		 Ded/Co-ins. Provider**
1/4/2017 97110,
97140,
G0283		 Physical Therapy $146.00 $96.57 $24.63 12
1/4/2017 90834 Psychotherapy $190.00 $70.80 $18.06 14
1/11/2017 90834 Psychotherapy $190.00 $70.80 $18.06 14
1/18/2017 99215 Office Visit $462.00 $0.00 $142.54 5
1/18/2017 90834 Psychotherapy $190.00 $70.80 $18.06 14
1/20/2017 00790 Anesthesia $1,575.50 $226.27 $98.18 1
1/20/2017 47382,
77013		 CT Guided
Procedure		 $2,503.00 $855.75 $218.31 9
1/20/2017 47382 RF Ablation $38,093.03 $4,703.05 $1,199.76 18
1/25/2017 90834 Psychotherapy $190.00 $70.80 $18.06 14
2/1/2017 90834 Psychotherapy $190.00 $70.80 $18.06 14
2/8/2017 90834 Psychotherapy $190.00 $70.80 $18.06 14
2/15/2017 90834 Psychotherapy $190.00 $70.80 $18.06 14
2/22/2017 90834 Psychotherapy $190.00 $70.80 $18.06 14
2/23/2017 74183 MRI $5,548.34 $440.75 $159.57 18
2/23/2017 74183 MRI Reading $305.00 $100.12 $25.54 16
3/1/2017 90834 Psychotherapy $190.00 $70.80 $18.06 14
3/8/2017 90834 Psychotherapy $190.00 $70.80 $18.06 14
3/8/2017 99215 Office Visit $462.00 $96.41 $24.60 5
3/8/2017 G0463 Hospital Clinic $268.00 $119.39 $30.47 18
3/15/2017 90834 Psychotherapy $190.00 $70.80 $18.06 14
3/22/2017 90834 Psychotherapy $190.00 $70.80 $18.06 14
3/27/2017 99215 Office Visit $462.00 $96.41 $24.60 5
3/27/2017 G0463 Hospital Clinic $268.00 $119.39 $30.47 18
3/29/2017 90834 Psychotherapy $190.00 $70.80 $18.06 14
3/30/2017 36415,
85025,
85610,
80053		 Blood Tests $178.91 $17.14 $79.30 18
3/31/2017 76700 Ultrasound $1,187.00 $127.49 $32.52 18
3/31/2017 76700 Ultrasound Reading $182.00 $33.63 $8.94 16
4/5/2017 90834 Psychotherapy $190.00 $70.80 $18.06 14
4/10/2017 71470 CT scan $3,845.71 $296.81 $75.73 18
4/10/2017 71470 CT reading $305.00 $63.27 $16.14 16
4/19/2017 90834 Psychotherapy $190.00 $70.80 $18.06 14
4/26/2017 90834 Psychotherapy $190.00 $70.80 $18.06 14
5/2/2017 90834 Psychotherapy $190.00 $70.80 $18.06 14
5/3/2017 99215 Office Visit $462.00 $96.41 $24.60 5
5/3/2017 G0463 Hospital Clinic $268.00 $119.39 $30.47 18
5/9/2017 90834 Psychotherapy $190.00 $70.80 $18.06 14
5/16/2017 90834 Psychotherapy $190.00 $70.80 $18.06 14
5/23/2017 90834 Psychotherapy $190.00 $70.80 $18.06 14
5/31/2017 90834 Psychotherapy $190.00 $70.80 $18.06 14
6/3/2017 74183 MRI $5,379.00 $440.75 $159.57 18
6/3/2017 74183 MRI Reading $305.00 $100.12 $25.54 16
6/6/2017 99214 Office Visit $250.00 $91.61 $23.85 13
6/7/2017 90834 Psychotherapy $190.00 $70.80 $18.06 14
6/14/2017 90834 Psychotherapy $190.00 $70.80 $18.06 14
6/21/2017 90834 Psychotherapy $190.00 $70.80 $18.06 14
6/27-7/3/2017 Hospitalization $287,536.38 $47,406.18 $1,316.00 18
6/27/2017 93010 EKG Reading $43.00 $7.57 $1.93 2
6/27/2017 99222 Hospital Visit $470.00 $121.77 $31.07 6
6/27/2017 47135 Transplant Surgery $20,477.00 $4,542.16 $1,158.72 17
6/27/2017 47135 Ass. Surgeon $4,095.40 $749.22 $191.13 17
6/28/2017 36556,
76937		 Anesthesia $2,702.50 $116.08 $29.61 1
6/28/2017 00796 Anesthesia $3,277.50 $887.11 $226.30 1
6/28/2017 00796,
36620,
76937		 Anesthesia $7,072.50 $1,027.08 $262.02 1
6/28/2017 71010 CXR Reading $52.00 $8.25 $2.10 16
6/28/2017 99375 Ultrasound Reading $367.00 $50.25 $12.82 16
6/28/2017 88305,
88307,
88309,
88313		 Pathology $2,075.00 $318.00 $81.17 11
6/28/2017 93010 EKG Reading $43.00 $7.57 $1.93 2
6/28/2017 99223 Hospital Visit $692.00 $175.45 $44.76 5
6/28/2017 99223 Hospital Visit $455.00 $180.88 $46.14 15
6/29/2017 99233 Hospital Visit $237.00 $93.27 $23.79 15
6/29/2017 99233 Hospital Visit $400.00 $90.46 $23.08 17
6/29/2017 99233 Hospital Visit $400.00 $90.46 $23.08 5
6/30/2017 99232 Hospital Visit $278.00 $62.68 $15.99 17
6/30/2017 99233 Hospital Visit $400.00 $90.46 $23.08 5
7/1/2017 99232 Hospital Visit $278.00 $62.68 $15.99 17
7/1/2017 99233 Hospital Visit $400.00 $93.27 $23.79 5
7/2/2017 99233 Hospital Visit $400.00 $93.27 $23.79 5
7/3/2017 99233 Hospital Visit $400.00 $93.27 $23.79 17
7/3/2017 99233 Hospital Visit $400.00 $93.27 $23.79 5
7/5/2017 Q0512,
J7512,
J7517,
J7507,
Q0510		 Medications $1,441.46 $423.07 $107.93 19
7/6/2017 G0463 Hospital Clinic $903.00 $119.39 $30.47 18
7/6/2017 99215 Office Visit $462.00 $99.39 $25.36 5
7/10/2017 99215 Office Visit $462.00 $96.41 $24.60 5
7/12-8/8/2017 Hospitalization $365,906.83 $46,182.26 $0.00 18
7/12/2017 93975 Ultrasound Reading $354.00 $51.28 $13.08 16
7/12/2017 99285 ER Visit $638.00 $139.35 $37.03 4
7/12/2017 99223 Hospital Visit $692.00 $180.88 $46.14 6
7/12/2017 99223 Hospital Visit $692.00 $175.45 $44.76 5
7/13/2017 71020 CXR Reading $63.00 $9.85 $2.51 16
7/13/2017 99223 Hospital Visit $692.00 $180.88 $46.14 17
7/13/2017 99233 Hospital Visit $400.00 $90.46 $23.08 5
7/14/2017 71275 CT Reading $272.00 $82.35 $21.01 16
7/14/2017 47000,
76942		 Liver Biopsy $527.00 $111.85 $28.54 9
7/14/2017 88307,
88313		 Pathology $731.00 $113.62 $28.98 11
7/14/2017 88312,
88341,
88342		 Pathology $1,706.00 $191.69 $48.90 11
7/14/2017 99232 Hospital Visit $278.00 $64.62 $16.48 17
7/14/2017 99233 Hospital Visit $400.00 $90.46 $23.08 5
7/15/2017 99233 Hospital Visit $400.00 $93.27 $23.79 17
7/15/2017 99233 Hospital Visit $400.00 $90.46 $23.08 5
7/16/2017 99233 Hospital Visit $400.00 $93.27 $23.79 17
7/16/2017 99233 Hospital Visit $400.00 $90.46 $23.08 5
7/17/2017 99233 Hospital Visit $400.00 $93.27 $23.79 17
7/17/2017 93975 Ultrasound Reading $346.00 $50.25 $12.82 16
7/17/2017 99233 Hospital Visit $400.00 $90.46 $23.08 5
7/18/2017 99233 Hospital Visit $400.00 $93.27 $23.79 17
7/18/2017 99223 Hospital Visit $345.68 $173.71 $45.22 7
7/18/2017 99233 Hospital Visit $400.00 $90.46 $23.08 5
7/19/2017 99233 Hospital Visit $177.59 $89.56 $23.32 7
7/19/2017 99358,
99233,
99356		 Hospital Visit $1,131.00 $268.16 $68.41 5
7/19/2017 47000,
76942		 Liver Biopsy $527.00 $111.85 $28.54 9
7/19/2017 88307,
88313		 Pathology $731.00 $113.62 $28.98 11
7/19/2017 99233 Hospital Visit $400.00 $93.27 $23.79 17
7/19/2017 71020 CXR Reading $63.00 $9.85 $2.51 16
7/20/2017 99291 Hospital Visit $478.50 $188.02 $48.95 7
7/20/2017 99291 Hospital Visit $500.00 $195.78 $49.94 15
7/20/2017 93010 EKG Reading $43.00 $7.57 $1.93 2
7/20/2017 71010, x 2,
93976,
74150		 Radiology (Mult.) $659.00 $106.15 $27.08 16
7/20/2017 36247,
75726,
76377,
99152		 Arterial Cath. $1,693.00 $351.56 $89.68 9
7/20/2017 99291,
99358,
99359		 Hospital Visit $2,607.00 $380.93 $97.18 5
7/20/2017 99291 Hospital Visit $1,010.00 $195.78 $49.94 17
7/21/2017 99291 Hospital Visit $500.00 $195.78 $49.94 15
7/21/2017 93010 EKG Reading $43.00 $7.57 $1.93 2
7/21/2017 99291 Hospital Visit $1,010.00 $189.00 $48.45 5
7/21/2017 99291 Hospital Visit $1,010.00 $195.78 $49.94 17
7/21/2017 99291 Hospital Visit $478.50 $188.02 $48.95 7
7/21/2017 71010 CXR Reading $52.00 $8.25 $2.10 16
7/22/2017 99291 Hospital Visit $478.50 $188.02 $48.95 7
7/22/2017 99291 Hospital Visit $500.00 $195.78 $49.94 15
7/22/2017 99233 Hospital Visit $400.00 $90.46 $23.08 5
7/22/2017 99291 Hospital Visit $1,010.00 $195.78 $49.94 17
7/23/2017 99233 Hospital Visit $237.00 $93.27 $23.79 15
7/23/2017 99233 Hospital Visit $400.00 $90.46 $23.08 5
7/23/2017 99291 Hospital Visit $1,010.00 $195.78 $49.94 17
7/24/2017 99233 Hospital Visit $177.59 $89.56 $23.32 7
7/24/2017 99232 Hospital Visit $164.00 $64.62 $16.48 15
7/24/2017 99233 Hospital Visit $400.00 $90.46 $23.08 5
7/24/2017 99233 Hospital Visit $400.00 $93.27 $23.79 17
7/25/2017 99233 Hospital Visit $177.59 $89.56 $23.32 7
7/25/2017 99232 Hospital Visit $164.00 $64.62 $16.48 15
7/25/2017 99233 Hospital Visit $400.00 $90.46 $23.08 5
7/25/2017 99233 Hospital Visit $400.00 $93.27 $23.79 17
7/25/2017 71010 CXR Reading $52.00 $8.25 $2.10 16
7/26/2017 99232 Hospital Visit $278.00 $64.62 $16.48 6
7/26/2017 99233 Hospital Visit $177.59 $89.56 $23.32 7
7/26/2017 99233 Hospital Visit $400.00 $90.46 $23.08 5
7/27/2017 99232 Hospital Visit $123.06 $62.06 $16.15 7
7/27/2017 99233 Hospital Visit $400.00 $90.46 $23.08 5
7/28/2017 99232 Hospital Visit $123.06 $62.06 $16.15 7
7/28/2017 99233 Hospital Visit $400.00 $90.46 $23.08 5
7/28/2017 99233 Hospital Visit $400.00 $93.27 $23.79 17
7/29/2017 99233 Hospital Visit $400.00 $90.46 $23.08 5
7/29/2017 99233 Hospital Visit $400.00 $93.27 $23.79 17
7/30/2017 99233 Hospital Visit $400.00 $90.46 $23.08 5
7/30/2017 99233 Hospital Visit $400.00 $93.27 $23.79 17
7/31/2017 99233 Hospital Visit $400.00 $90.46 $23.08 5
7/31/2017 99233 Hospital Visit $400.00 $93.27 $23.79 17
7/31/2017 99233 Hospital Visit $177.59 $89.56 $23.32 7
8/1/2017 99233 Hospital Visit $400.00 $90.46 $23.08 5
8/1/2017 99233 Hospital Visit $400.00 $93.27 $23.79 17
8/2/2017 99233 Hospital Visit $400.00 $90.46 $23.08 5
8/2/2017 99233 Hospital Visit $400.00 $93.27 $23.79 17
8/3/2017 99233 Hospital Visit $400.00 $90.46 $23.08 5
8/3/2017 99233 Hospital Visit $400.00 $93.27 $23.79 17
8/4/2017 99233 Hospital Visit $177.59 $89.56 $23.32 7
8/4/2017 99233 Hospital Visit $400.00 $90.46 $23.08 5
8/4/2017 99233 Hospital Visit $400.00 $93.27 $23.79 17
8/5/2017 99233 Hospital Visit $400.00 $90.46 $23.08 5
8/5/2017 99233 Hospital Visit $400.00 $93.27 $23.79 17
8/6/2017 99233 Hospital Visit $400.00 $90.46 $23.08 5
8/7/2017 99232 Hospital Visit $278.00 $64.62 $16.48 17
8/7/2017 99233 Hospital Visit $400.00 $90.46 $23.08 5
8/8/2017 99232 Hospital Visit $278.00 $64.62 $16.48 17
8/8/2017 99233 Hospital Visit $400.00 $90.46 $23.08 5
8/10/2017 76705,
93975,
G0463		 Ultrasound x 2,
Hospital Clinic		 $4,293.21 $498.65 $127.24 18
8/10/2017 93976 Ultrasound Reading $286.00 $35.93 $9.17 16
8/10/2017 99215 Office Visit $462.00 $99.39 $25.36 5
8/14/2017 99215 Office Visit $462.00 $96.41 $24.60 5
8/14/2017 G0463 Hospital Clinic $895.00 $119.39 $30.47 18
8/17/2017 99371 Ultrasound $1,785.00 $126.25 $32.21 18
8/17/2017 99371 Ultrasound Reading $135.00 $19.74 $5.03 16
8/24/2017 76705,
93975,
G0463		 Ultrasound x 2,
Hospital Clinic		 $5,039.42 $498.65 $127.24 18
8/24/2017 76705,
93976		 Ultrasound Reading $286.00 $62.58 $15.97 16
8/24/2017 99214 Office Visit $193.44 $97.28 $25.32 7
8/24/2017 99215 Office Visit $462.00 $99.39 $25.36 5
8/31/2017 99215 Office Visit $462.00 $96.41 $24.60 5
8/31/2017 G0463 Hospital Clinic $1,674.42 $119.39 $30.47 18
9/5-9/21/2017 70120,
G0463 x 2		 Hospital Clinics
and CXR		 $3,543.84 $305.81 $78.05 18
9/11/2017 99215 Office Visit $462.00 $96.41 $24.60 5
9/11/2017 71020 CXR Reading $63.00 $9.85 $2.51 16
9/14/2017 83735,
36415,
85025,
85610,
82248,
80053,
80197		 Blood Tests $450.33 $51.33 $55.12 18
9/21/2017 99215 Office Visit $462.00 $96.41 $24.60 5
9/25/2017 99213 Office Visit $110.00 $65.10 $16.61 8
9/25/2017 83735,
36415,
85025,
85610,
82248,
80053,
80197		 Blood Tests $450.33 $51.33 $55.12 18
10/2/2017 Q0511,
J7512		 Medications $44.99 $22.35 $5.70 19
10/6-10/12/2017 Hospitalization $48,673.78 $10,265.03 $0.00 18
10/6/2017 99223 Hospital Visit $692.00 $180.88 $46.14 6
10/7/2017 85060 Pathology $119.00 $23.05 $5.88 11
10/7/2017 99223 Hospital Visit $692.00 $180.88 $46.14 17
10/7/2017 99223 Hospital Visit $692.00 $180.88 $46.14 5
10/7/2017 99223 Hospital Visit $345.68 $173.71 $45.22 7
10/8/2017 99232 Hospital Visit $123.06 $62.06 $16.15 7
10/8/2017 99233 Hospital Visit $400.00 $93.27 $23.79 17
10/8/2017 99233 Hospital Visit $400.00 $93.27 $23.79 5
10/9/2017 99233 Hospital Visit $400.00 $93.27 $23.79 17
10/9/2017 99233 Hospital Visit $400.00 $93.27 $23.79 5
10/9/2017 99233 Hospital Visit $177.59 $89.56 $23.32 7
10/10/2017 99233 Hospital Visit $177.59 $89.56 $23.32 7
10/10/2017 99233 Hospital Visit $400.00 $93.27 $23.79 17
10/10/2017 99233 Hospital Visit $400.00 $93.27 $23.79 5
10/11/2017 99233 Hospital Visit $177.59 $89.56 $23.32 7
10/11/2017 99233 Hospital Visit $400.00 $93.27 $23.79 17
10/11/2017 99233 Hospital Visit $400.00 $93.27 $23.79 5
10/12/2017 99232 Hospital Visit $123.06 $62.06 $16.15 7
10/12/2017 99233 Hospital Visit $400.00 $93.27 $23.79 17
10/12/2017 99233 Hospital Visit $400.00 $93.27 $23.79 5
10/13/2017 Q0511,
J7505,
Q0512		 Medications $1,899.28 $188.73 $48.19 19
10/16/2017 99215 Office Visit $462.00 $96.41 $24.60 5
10/16-10/26/2017 76705,
99375,
G0463 x 2		 Hospital Clinics,
Ultrasounds x 2		 $6,431.42 $618.04 $157.71 18
10/20/2017 90653,
G0008		 Flu Vaccine $90.00 $80.10 $0.00 8
10/20/2017 99495 Office Visit $200.00 $146.70 $37.42 8
10/23/2017 76705,
93976		 Ultrasound Reading $286.00 $61.33 $15.64 16
10/23/2017 99215 Office Visit $462.00 $96.41 $24.60 5
11/13/2017 99215 Office Visit $462.00 $96.41 $24.60 5
11/13/2017 G0463 Hospital Clinic $929.91 $119.39 $30.47 18
12/14/2017 99215 Office Visit $462.00 $96.41 $24.60 5
12/14/2017 G0463 Hospital Clinic $268.00 $119.39 $30.47 18
Totals $900,743.84 $139,805.66 $10,916.99

*The codes listed are only the ones paid by any any payee. Codes that weren’t paid by any party aren’t listed, though all charges associated with an allowed service are included in total charges for that service (including charges for unpaid codes).

**Provider codes are as follows:
1-Anesthesia, 2-Cardiology, 3-Dermatology, 4-ER, 5-GI/Liver, 6-Hospitalist, 7-Infectious Disease, 8-Internal Medicine, 9-Interventional Radiology, 10-OB/Gyn, 11-Pathology, 12-Physical Therapy, 13-Psychiatry, 14-Psychologist, 15-Pulmonary, 16-Radiology, 17-Surgeon, 18-Hospital, 19-Pharmacy

Medical Services in 2018

Date Code* Service Charge* Medicare
Payment		 Ded/Co-ins. Provider**
1/8/2018 99213 Office Visit $110.00 $0.00 $87.25 8
1/23/2018 J7507,
Q0511		 Medications $1,709.99 $81.81 $116.62 19
2/7/2018 99213 Office Visit $135.00 $71.47 $17.10 3
3/5/2018 G0463 Hospital Clinic $273.00 $127.22 $32.45 18
3/5/2018 99215 Office Visit $473.00 $95.75 $24.43 5
4/9/2018 99213 Office Visit $110.00 $66.35 $16.93 8
5/22/2018 J7507,
Q0511		 Medications $1,709.99 $141.83 $36.18 19
6/20/2018 71260 CT Scan $3,580.00 $560.46 $142.97 18
6/20/2018 74170, 71260 CT reading $574.00 $115.76 $29.53 16
6/22/2018 J7507,
Q0511		 Medications $93.59 $24.97 $6.37 19
7/9/2018 99213 Office Visit $110.00 $66.35 $16.93 8
Totals $8,878.57 $1,351.97 $526.76

*The codes listed are only the ones paid by any any payee. Codes that weren’t paid by any party aren’t listed, though all charges associated with an allowed service are included in total charges for that service (including charges for unpaid codes).

**Provider codes are as follows:
1-Anesthesia, 2-Cardiology, 3-Dermatology, 4-ER, 5-GI/Liver, 6-Hospitalist, 7-Infectious Disease, 8-Internal Medicine, 9-Interventional Radiology, 10-OB/Gyn, 11-Pathology, 12-Physical Therapy, 13-Psychiatry, 14-Psychologist, 15-Pulmonary, 16-Radiology, 17-Surgeon, 18-Hospital, 19-Pharmacy