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