Service Area|Px Code|Procedure Description|Default Rev Code|CPT(R)/HCPCS Code|Default Mod|Fee Schedule Group Name|Unit Price PEMBINA COUNTY MEDICAL CENTER|11005|SURG CLEANSING ABD WALL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11005||PC STANDARD FEE SCHEDULE|1,919.00 PEMBINA COUNTY MEDICAL CENTER|11005|SURG CLEANSING ABD WALL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11005||PC M/M HB CLINIC|1,919.00 PEMBINA COUNTY MEDICAL CENTER|11006|SURG CLEANS ABD WALL,GENITAL, PERIN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11006||PC STANDARD FEE SCHEDULE|1,729.00 PEMBINA COUNTY MEDICAL CENTER|11006|SURG CLEANS ABD WALL,GENITAL, PERIN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11006||PC M/M HB CLINIC|1,729.00 PEMBINA COUNTY MEDICAL CENTER|11008|REMOVE MESH FROM ABD WALL|PROFESSIONAL FEES - OPERATING ROOM [0975]|11008||PC STANDARD FEE SCHEDULE|677.00 PEMBINA COUNTY MEDICAL CENTER|11008|REMOVE MESH FROM ABD WALL|PROFESSIONAL FEES - OPERATING ROOM [0975]|11008||PC M/M HB CLINIC|677.00 PEMBINA COUNTY MEDICAL CENTER|97597|DEBRIDEMENT OPEN WOUND 20 SQ CM<|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|97597||PC STANDARD FEE SCHEDULE|59.00 PEMBINA COUNTY MEDICAL CENTER|97597|DEBRIDEMENT OPEN WOUND 20 SQ CM<|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|97597||PC M/M HB CLINIC|59.00 PEMBINA COUNTY MEDICAL CENTER|97605|NEGATIVE PRESSURE WOUND THERAPY DME 4CM TRUNK,ARM,LEG|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11406||PC STANDARD FEE SCHEDULE|611.00 PEMBINA COUNTY MEDICAL CENTER|11406|EXC SKIN BENIG >4CM TRUNK,ARM,LEG|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11406||PC M/M HB CLINIC|611.00 PEMBINA COUNTY MEDICAL CENTER|11420|EXC SKIN BENIG <5MM REMAINDR BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11420||PC STANDARD FEE SCHEDULE|204.00 PEMBINA COUNTY MEDICAL CENTER|11420|EXC SKIN BENIG <5MM REMAINDR BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11420||PC M/M HB CLINIC|204.00 PEMBINA COUNTY MEDICAL CENTER|11421|EXC SKIN BENIG 0.6-1CM REMAINDR BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11421||PC STANDARD FEE SCHEDULE|278.00 PEMBINA COUNTY MEDICAL CENTER|11421|EXC SKIN BENIG 0.6-1CM REMAINDR BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11421||PC M/M HB CLINIC|278.00 PEMBINA COUNTY MEDICAL CENTER|11422|EXC SKIN BENIG 1.1-2CM REMAINDR BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11422||PC STANDARD FEE SCHEDULE|340.00 PEMBINA COUNTY MEDICAL CENTER|11422|EXC SKIN BENIG 1.1-2CM REMAINDR BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11422||PC M/M HB CLINIC|340.00 PEMBINA COUNTY MEDICAL CENTER|11423|EXC SKIN BENIG 2.1-3CM REMAINDR BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11423||PC STANDARD FEE SCHEDULE|396.00 PEMBINA COUNTY MEDICAL CENTER|11423|EXC SKIN BENIG 2.1-3CM REMAINDR BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11423||PC M/M HB CLINIC|396.00 PEMBINA COUNTY MEDICAL CENTER|11424|EXC SKIN BENIG 3.1-4CM REMAINDR BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11424||PC STANDARD FEE SCHEDULE|448.00 PEMBINA COUNTY MEDICAL CENTER|11424|EXC SKIN BENIG 3.1-4CM REMAINDR BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11424||PC M/M HB CLINIC|448.00 PEMBINA COUNTY MEDICAL CENTER|11426|EXC SKIN BENIG >4CM REMAINDR BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11426||PC STANDARD FEE SCHEDULE|681.00 PEMBINA COUNTY MEDICAL CENTER|11426|EXC SKIN BENIG >4CM REMAINDR BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11426||PC M/M HB CLINIC|681.00 PEMBINA COUNTY MEDICAL CENTER|11440|EXC SKIN BENIG <5MM FACE,FACIAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11440||PC STANDARD FEE SCHEDULE|263.00 PEMBINA COUNTY MEDICAL CENTER|11440|EXC SKIN BENIG <5MM FACE,FACIAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11440||PC M/M HB CLINIC|263.00 PEMBINA COUNTY MEDICAL CENTER|11441|EXC SKIN BENIG 0.6-1CM FACE,FACIAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11441||PC STANDARD FEE SCHEDULE|331.00 PEMBINA COUNTY MEDICAL CENTER|11441|EXC SKIN BENIG 0.6-1CM FACE,FACIAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11441||PC M/M HB CLINIC|331.00 PEMBINA COUNTY MEDICAL CENTER|11442|EXC SKIN BENIG 1.1-2CM FACE,FACIAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11442||PC STANDARD FEE SCHEDULE|366.00 PEMBINA COUNTY MEDICAL CENTER|11442|EXC SKIN BENIG 1.1-2CM FACE,FACIAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11442||PC M/M HB CLINIC|366.00 PEMBINA COUNTY MEDICAL CENTER|11443|EXC SKIN BENIG 2.1-3CM FACE,FACIAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11443||PC STANDARD FEE SCHEDULE|446.00 PEMBINA COUNTY MEDICAL CENTER|11443|EXC SKIN BENIG 2.1-3CM FACE,FACIAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11443||PC M/M HB CLINIC|446.00 PEMBINA COUNTY MEDICAL CENTER|11444|EXC SKIN BENIG 3.1-4CM FACE,FACIAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11444||PC STANDARD FEE SCHEDULE|564.00 PEMBINA COUNTY MEDICAL CENTER|11444|EXC SKIN BENIG 3.1-4CM FACE,FACIAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11444||PC M/M HB CLINIC|564.00 PEMBINA COUNTY MEDICAL CENTER|11450|EXC SWEAT GLAND LESN AXILL,SIMPL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11450||PC STANDARD FEE SCHEDULE|630.00 PEMBINA COUNTY MEDICAL CENTER|11450|EXC SWEAT GLAND LESN AXILL,SIMPL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11450||PC M/M HB CLINIC|630.00 PEMBINA COUNTY MEDICAL CENTER|11451|EXC SWEAT GLAND LESN AXILL,COMPLX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11451||PC STANDARD FEE SCHEDULE|807.00 PEMBINA COUNTY MEDICAL CENTER|11451|EXC SWEAT GLAND LESN AXILL,COMPLX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11451||PC M/M HB CLINIC|807.00 PEMBINA COUNTY MEDICAL CENTER|11600|EXC SKIN MALIG <5MM TRUNK,ARM,LEG|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11600||PC STANDARD FEE SCHEDULE|300.00 PEMBINA COUNTY MEDICAL CENTER|11600|EXC SKIN MALIG <5MM TRUNK,ARM,LEG|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11600||PC M/M HB CLINIC|300.00 PEMBINA COUNTY MEDICAL CENTER|11601|EXC SKIN MALIG 0.6-1CM TRUNK,ARM,LEG|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11601||PC STANDARD FEE SCHEDULE|373.00 PEMBINA COUNTY MEDICAL CENTER|11601|EXC SKIN MALIG 0.6-1CM TRUNK,ARM,LEG|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11601||PC M/M HB CLINIC|373.00 PEMBINA COUNTY MEDICAL CENTER|11602|EXC SKIN MALIG 1.1-2CM TRUNK,ARM,LEG|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11602||PC STANDARD FEE SCHEDULE|409.00 PEMBINA COUNTY MEDICAL CENTER|11602|EXC SKIN MALIG 1.1-2CM TRUNK,ARM,LEG|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11602||PC M/M HB CLINIC|409.00 PEMBINA COUNTY MEDICAL CENTER|11603|EXC SKIN MALIG 2.1-3CM TRUNK,ARM,LEG|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11603||PC STANDARD FEE SCHEDULE|485.00 PEMBINA COUNTY MEDICAL CENTER|11603|EXC SKIN MALIG 2.1-3CM TRUNK,ARM,LEG|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11603||PC M/M HB CLINIC|485.00 PEMBINA COUNTY MEDICAL CENTER|11604|EXC SKIN MALIG 3.1-4CM TRUNK,ARM,LEG|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11604||PC STANDARD FEE SCHEDULE|536.00 PEMBINA COUNTY MEDICAL CENTER|11604|EXC SKIN MALIG 3.1-4CM TRUNK,ARM,LEG|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11604||PC M/M HB CLINIC|536.00 PEMBINA COUNTY MEDICAL CENTER|11606|EXC SKIN MALIG >4CM TRUNK,ARM,LEG|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11606||PC STANDARD FEE SCHEDULE|792.00 PEMBINA COUNTY MEDICAL CENTER|11606|EXC SKIN MALIG >4CM TRUNK,ARM,LEG|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11606||PC M/M HB CLINIC|792.00 PEMBINA COUNTY MEDICAL CENTER|11621|EXC SKIN MALIG 0.6-1CM REMAINDR BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11621||PC STANDARD FEE SCHEDULE|375.00 PEMBINA COUNTY MEDICAL CENTER|11621|EXC SKIN MALIG 0.6-1CM REMAINDR BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11621||PC M/M HB CLINIC|375.00 PEMBINA COUNTY MEDICAL CENTER|11622|EXC SKIN MALIG 1.1-2CM REMAINDR BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11622||PC STANDARD FEE SCHEDULE|429.00 PEMBINA COUNTY MEDICAL CENTER|11622|EXC SKIN MALIG 1.1-2CM REMAINDR BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11622||PC M/M HB CLINIC|429.00 PEMBINA COUNTY MEDICAL CENTER|11623|EXC SKIN MALIG 2.1-3CM REMAINDR BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11623||PC STANDARD FEE SCHEDULE|528.00 PEMBINA COUNTY MEDICAL CENTER|11623|EXC SKIN MALIG 2.1-3CM REMAINDR BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11623||PC M/M HB CLINIC|528.00 PEMBINA COUNTY MEDICAL CENTER|11624|EXC SKIN MALIG 3.1-4CM REMAINDR BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11624||PC STANDARD FEE SCHEDULE|597.00 PEMBINA COUNTY MEDICAL CENTER|11624|EXC SKIN MALIG 3.1-4CM REMAINDR BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11624||PC M/M HB CLINIC|597.00 PEMBINA COUNTY MEDICAL CENTER|11626|EXC SKIN MALIG >4CM REMAINDR BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11626||PC STANDARD FEE SCHEDULE|730.00 PEMBINA COUNTY MEDICAL CENTER|11626|EXC SKIN MALIG >4CM REMAINDR BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11626||PC M/M HB CLINIC|730.00 PEMBINA COUNTY MEDICAL CENTER|11640|EXC SKIN MALIG <5MM FACE,FACIAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11640||PC STANDARD FEE SCHEDULE|313.00 PEMBINA COUNTY MEDICAL CENTER|11640|EXC SKIN MALIG <5MM FACE,FACIAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11640||PC M/M HB CLINIC|313.00 PEMBINA COUNTY MEDICAL CENTER|11641|EXC SKIN MALIG 0.6-1CM FACE,FACIAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11641||PC STANDARD FEE SCHEDULE|391.00 PEMBINA COUNTY MEDICAL CENTER|11641|EXC SKIN MALIG 0.6-1CM FACE,FACIAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11641||PC M/M HB CLINIC|391.00 PEMBINA COUNTY MEDICAL CENTER|11642|EXC SKIN MALIG 1.1-2CM FACE,FACIAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11642||PC STANDARD FEE SCHEDULE|458.00 PEMBINA COUNTY MEDICAL CENTER|11642|EXC SKIN MALIG 1.1-2CM FACE,FACIAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11642||PC M/M HB CLINIC|458.00 PEMBINA COUNTY MEDICAL CENTER|11643|EXC SKIN MALIG 2.1-3CM FACE,FACIAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11643||PC STANDARD FEE SCHEDULE|574.00 PEMBINA COUNTY MEDICAL CENTER|11643|EXC SKIN MALIG 2.1-3CM FACE,FACIAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11643||PC M/M HB CLINIC|574.00 PEMBINA COUNTY MEDICAL CENTER|11644|EXC SKIN MALIG 3.1-4CM FACE,FACIAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11644||PC STANDARD FEE SCHEDULE|709.00 PEMBINA COUNTY MEDICAL CENTER|11644|EXC SKIN MALIG 3.1-4CM FACE,FACIAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11644||PC M/M HB CLINIC|709.00 PEMBINA COUNTY MEDICAL CENTER|11646|EXC SKIN MALIG >4CM FACE,FACIAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11646||PC STANDARD FEE SCHEDULE|982.00 PEMBINA COUNTY MEDICAL CENTER|11646|EXC SKIN MALIG >4CM FACE,FACIAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11646||PC M/M HB CLINIC|982.00 PEMBINA COUNTY MEDICAL CENTER|11720|DEBRIDEMENT OF NAIL(S), 1-5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11720||PC STANDARD FEE SCHEDULE|37.00 PEMBINA COUNTY MEDICAL CENTER|11720|DEBRIDEMENT OF NAIL(S), 1-5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11720||PC M/M HB CLINIC|37.00 PEMBINA COUNTY MEDICAL CENTER|11730|REMOVAL OF NAIL PLATE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11730||PC STANDARD FEE SCHEDULE|124.00 PEMBINA COUNTY MEDICAL CENTER|11730|REMOVAL OF NAIL PLATE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11730||PC M/M HB CLINIC|124.00 PEMBINA COUNTY MEDICAL CENTER|11740|DRAIN BLOOD FROM UNDER NAIL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11740||PC STANDARD FEE SCHEDULE|82.00 PEMBINA COUNTY MEDICAL CENTER|11740|DRAIN BLOOD FROM UNDER NAIL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11740||PC M/M HB CLINIC|82.00 PEMBINA COUNTY MEDICAL CENTER|11750|REMOVAL OF NAIL BED|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11750||PC STANDARD FEE SCHEDULE|432.00 PEMBINA COUNTY MEDICAL CENTER|11750|REMOVAL OF NAIL BED|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11750||PC M/M HB CLINIC|432.00 PEMBINA COUNTY MEDICAL CENTER|11760|RECONSTRUC OF NAIL BED|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11760||PC STANDARD FEE SCHEDULE|335.00 PEMBINA COUNTY MEDICAL CENTER|11760|RECONSTRUC OF NAIL BED|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11760||PC M/M HB CLINIC|335.00 PEMBINA COUNTY MEDICAL CENTER|11765|EXCISION OF NAIL FOLD, TOE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11765||PC STANDARD FEE SCHEDULE|233.00 PEMBINA COUNTY MEDICAL CENTER|11765|EXCISION OF NAIL FOLD, TOE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|11765||PC M/M HB CLINIC|233.00 PEMBINA COUNTY MEDICAL CENTER|11771|REMV PILONIDAL LESION EXTENS|PROFESSIONAL FEES - OPERATING ROOM [0975]|11771||PC STANDARD FEE SCHEDULE|1,062.00 PEMBINA COUNTY MEDICAL CENTER|11771|REMV PILONIDAL LESION EXTENS|PROFESSIONAL FEES - OPERATING ROOM [0975]|11771||PC M/M HB CLINIC|1,062.00 PEMBINA COUNTY MEDICAL CENTER|12001|REPR SUPERF WND BODY <2.5CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12001||PC STANDARD FEE SCHEDULE|112.00 PEMBINA COUNTY MEDICAL CENTER|12001|REPR SUPERF WND BODY <2.5CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12001||PC M/M HB CLINIC|112.00 PEMBINA COUNTY MEDICAL CENTER|12002|REPR SUP NPTERF WND BODY 2.6-7.5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12002||PC STANDARD FEE SCHEDULE|149.00 PEMBINA COUNTY MEDICAL CENTER|12002|REPR SUP NPTERF WND BODY 2.6-7.5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12002||PC M/M HB CLINIC|149.00 PEMBINA COUNTY MEDICAL CENTER|12004|REPR SUPERF WND BODY 7.6-12.5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12004||PC STANDARD FEE SCHEDULE|182.00 PEMBINA COUNTY MEDICAL CENTER|12004|REPR SUPERF WND BODY 7.6-12.5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12004||PC M/M HB CLINIC|182.00 PEMBINA COUNTY MEDICAL CENTER|12005|REPR SUPERF WND BODY 12.6-20|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12005||PC STANDARD FEE SCHEDULE|247.00 PEMBINA COUNTY MEDICAL CENTER|12005|REPR SUPERF WND BODY 12.6-20|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12005||PC M/M HB CLINIC|247.00 PEMBINA COUNTY MEDICAL CENTER|12006|REPR SUPERF WND BODY 20.1-30|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12006||PC STANDARD FEE SCHEDULE|300.00 PEMBINA COUNTY MEDICAL CENTER|12006|REPR SUPERF WND BODY 20.1-30|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12006||PC M/M HB CLINIC|300.00 PEMBINA COUNTY MEDICAL CENTER|12007|REPR SUPERF WND BODY >30CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12007||PC STANDARD FEE SCHEDULE|376.00 PEMBINA COUNTY MEDICAL CENTER|12007|REPR SUPERF WND BODY >30CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12007||PC M/M HB CLINIC|376.00 PEMBINA COUNTY MEDICAL CENTER|12011|REPR SUPERF WND FACE <2.5CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12011||PC STANDARD FEE SCHEDULE|139.00 PEMBINA COUNTY MEDICAL CENTER|12011|REPR SUPERF WND FACE <2.5CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12011||PC M/M HB CLINIC|139.00 PEMBINA COUNTY MEDICAL CENTER|12013|REPR SUPERF WND FACE 2.6-5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12013||PC STANDARD FEE SCHEDULE|154.00 PEMBINA COUNTY MEDICAL CENTER|12013|REPR SUPERF WND FACE 2.6-5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12013||PC M/M HB CLINIC|154.00 PEMBINA COUNTY MEDICAL CENTER|12014|REPR SUPERF WND FACE 5.1-7.5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12014||PC STANDARD FEE SCHEDULE|197.00 PEMBINA COUNTY MEDICAL CENTER|12014|REPR SUPERF WND FACE 5.1-7.5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12014||PC M/M HB CLINIC|197.00 PEMBINA COUNTY MEDICAL CENTER|12015|REPR SUPERF WND FACE 7.6-12.5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12015||PC STANDARD FEE SCHEDULE|244.00 PEMBINA COUNTY MEDICAL CENTER|12015|REPR SUPERF WND FACE 7.6-12.5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12015||PC M/M HB CLINIC|244.00 PEMBINA COUNTY MEDICAL CENTER|12016|REPR SUPERF WND FACE 12.6-20|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12016||PC STANDARD FEE SCHEDULE|331.00 PEMBINA COUNTY MEDICAL CENTER|12016|REPR SUPERF WND FACE 12.6-20|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12016||PC M/M HB CLINIC|331.00 PEMBINA COUNTY MEDICAL CENTER|12017|REPR SUPERF WND FACE 20.1-30|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12017||PC STANDARD FEE SCHEDULE|378.00 PEMBINA COUNTY MEDICAL CENTER|12017|REPR SUPERF WND FACE 20.1-30|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12017||PC M/M HB CLINIC|378.00 PEMBINA COUNTY MEDICAL CENTER|12018|REPR SUPERF WND FACE >30CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12018||PC STANDARD FEE SCHEDULE|502.00 PEMBINA COUNTY MEDICAL CENTER|12018|REPR SUPERF WND FACE >30CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12018||PC M/M HB CLINIC|502.00 PEMBINA COUNTY MEDICAL CENTER|12020|CLOSURE SUPERF WND DEHIS SIMPLE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12020||PC STANDARD FEE SCHEDULE|471.00 PEMBINA COUNTY MEDICAL CENTER|12020|CLOSURE SUPERF WND DEHIS SIMPLE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12020||PC M/M HB CLINIC|471.00 PEMBINA COUNTY MEDICAL CENTER|12031|LAYR CLOS WND TRUNK,ARM,LEG <2.5CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12031||PC STANDARD FEE SCHEDULE|385.00 PEMBINA COUNTY MEDICAL CENTER|12031|LAYR CLOS WND TRUNK,ARM,LEG <2.5CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12031||PC M/M HB CLINIC|385.00 PEMBINA COUNTY MEDICAL CENTER|12032|LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12032||PC STANDARD FEE SCHEDULE|490.00 PEMBINA COUNTY MEDICAL CENTER|12032|LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12032||PC M/M HB CLINIC|490.00 PEMBINA COUNTY MEDICAL CENTER|12034|LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12034||PC STANDARD FEE SCHEDULE|516.00 PEMBINA COUNTY MEDICAL CENTER|12034|LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12034||PC M/M HB CLINIC|516.00 PEMBINA COUNTY MEDICAL CENTER|12035|LAYR CLOS WND TRUNK,ARM,LEG 12.6-20|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12035||PC STANDARD FEE SCHEDULE|605.00 PEMBINA COUNTY MEDICAL CENTER|12035|LAYR CLOS WND TRUNK,ARM,LEG 12.6-20|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12035||PC M/M HB CLINIC|605.00 PEMBINA COUNTY MEDICAL CENTER|12036|LAYR CLOS WND TRUNK,ARM,LEG 20.1-30|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12036||PC STANDARD FEE SCHEDULE|699.00 PEMBINA COUNTY MEDICAL CENTER|12036|LAYR CLOS WND TRUNK,ARM,LEG 20.1-30|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12036||PC M/M HB CLINIC|699.00 PEMBINA COUNTY MEDICAL CENTER|12041|LAYR CLOS WND REST BODY <2.5CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12041||PC STANDARD FEE SCHEDULE|392.00 PEMBINA COUNTY MEDICAL CENTER|12041|LAYR CLOS WND REST BODY <2.5CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12041||PC M/M HB CLINIC|392.00 PEMBINA COUNTY MEDICAL CENTER|12042|LAYR CLOS WND REST BODY 2.6-7.5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12042||PC STANDARD FEE SCHEDULE|501.00 PEMBINA COUNTY MEDICAL CENTER|12042|LAYR CLOS WND REST BODY 2.6-7.5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12042||PC M/M HB CLINIC|501.00 PEMBINA COUNTY MEDICAL CENTER|12045|LAYR CLOS WND REST BODY 12.6-20|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12045||PC STANDARD FEE SCHEDULE|681.00 PEMBINA COUNTY MEDICAL CENTER|12045|LAYR CLOS WND REST BODY 12.6-20|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12045||PC M/M HB CLINIC|681.00 PEMBINA COUNTY MEDICAL CENTER|12051|LAYR CLOS WND FACE,FACIAL <2.5CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12051||PC STANDARD FEE SCHEDULE|431.00 PEMBINA COUNTY MEDICAL CENTER|12051|LAYR CLOS WND FACE,FACIAL <2.5CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12051||PC M/M HB CLINIC|431.00 PEMBINA COUNTY MEDICAL CENTER|12052|LAYR CLOS WND FACE,FACIAL 2.5-5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12052||PC STANDARD FEE SCHEDULE|509.00 PEMBINA COUNTY MEDICAL CENTER|12052|LAYR CLOS WND FACE,FACIAL 2.5-5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12052||PC M/M HB CLINIC|509.00 PEMBINA COUNTY MEDICAL CENTER|12053|LAYR CLOS WND FACE,FACIAL 5.1-7.5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12053||PC STANDARD FEE SCHEDULE|542.00 PEMBINA COUNTY MEDICAL CENTER|12053|LAYR CLOS WND FACE,FACIAL 5.1-7.5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|12053||PC M/M HB CLINIC|542.00 PEMBINA COUNTY MEDICAL CENTER|13100|REPR CMPL WND TRUNK 1.1-2.5CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|13100||PC STANDARD FEE SCHEDULE|513.00 PEMBINA COUNTY MEDICAL CENTER|13100|REPR CMPL WND TRUNK 1.1-2.5CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|13100||PC M/M HB CLINIC|513.00 PEMBINA COUNTY MEDICAL CENTER|13101|REPR CMPL WND TRUNK 2.6-7.5CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|13101||PC STANDARD FEE SCHEDULE|636.00 PEMBINA COUNTY MEDICAL CENTER|13101|REPR CMPL WND TRUNK 2.6-7.5CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|13101||PC M/M HB CLINIC|636.00 PEMBINA COUNTY MEDICAL CENTER|13102|REP,SKIN,TRUNK,CMPLX,+5CM/<|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|13102||PC STANDARD FEE SCHEDULE|184.00 PEMBINA COUNTY MEDICAL CENTER|13102|REP,SKIN,TRUNK,CMPLX,+5CM/<|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|13102||PC M/M HB CLINIC|184.00 PEMBINA COUNTY MEDICAL CENTER|13120|REPR CMPL WND SCALP,EXTR 1.1-2.5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|13120||PC STANDARD FEE SCHEDULE|593.00 PEMBINA COUNTY MEDICAL CENTER|13120|REPR CMPL WND SCALP,EXTR 1.1-2.5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|13120||PC M/M HB CLINIC|593.00 PEMBINA COUNTY MEDICAL CENTER|13121|REPR CMPL WND SCALP,EXTR 2.6-7.5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|13121||PC STANDARD FEE SCHEDULE|665.00 PEMBINA COUNTY MEDICAL CENTER|13121|REPR CMPL WND SCALP,EXTR 2.6-7.5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|13121||PC M/M HB CLINIC|665.00 PEMBINA COUNTY MEDICAL CENTER|13122|REP,SKIN,SCALP/EXTREM+5CM/<|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|13122||PC STANDARD FEE SCHEDULE|215.00 PEMBINA COUNTY MEDICAL CENTER|13122|REP,SKIN,SCALP/EXTREM+5CM/<|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|13122||PC M/M HB CLINIC|215.00 PEMBINA COUNTY MEDICAL CENTER|13131|REPR CMPL WND HEAD,FAC,HAND 1.1-2.5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|13131||PC STANDARD FEE SCHEDULE|623.00 PEMBINA COUNTY MEDICAL CENTER|13131|REPR CMPL WND HEAD,FAC,HAND 1.1-2.5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|13131||PC M/M HB CLINIC|623.00 PEMBINA COUNTY MEDICAL CENTER|13132|REPR CMPL WND HEAD,FAC,HAND 2.6-7.5|PROFESSIONAL FEES - OPERATING ROOM [0975]|13132||PC STANDARD FEE SCHEDULE|784.00 PEMBINA COUNTY MEDICAL CENTER|13132|REPR CMPL WND HEAD,FAC,HAND 2.6-7.5|PROFESSIONAL FEES - OPERATING ROOM [0975]|13132||PC M/M HB CLINIC|784.00 PEMBINA COUNTY MEDICAL CENTER|13133|REP,FACE,GENITAL,HAND,FT+5CM/<|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|13133||PC STANDARD FEE SCHEDULE|324.00 PEMBINA COUNTY MEDICAL CENTER|13133|REP,FACE,GENITAL,HAND,FT+5CM/<|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|13133||PC M/M HB CLINIC|324.00 PEMBINA COUNTY MEDICAL CENTER|13152|REPR CMPL WND LID,NOS,EAR 2.5-7.5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|13152||PC STANDARD FEE SCHEDULE|800.00 PEMBINA COUNTY MEDICAL CENTER|13152|REPR CMPL WND LID,NOS,EAR 2.5-7.5|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|13152||PC M/M HB CLINIC|800.00 PEMBINA COUNTY MEDICAL CENTER|13160|SECD CLOS SURG WND EXTEN/COMPLIC|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|13160||PC STANDARD FEE SCHEDULE|2,010.00 PEMBINA COUNTY MEDICAL CENTER|13160|SECD CLOS SURG WND EXTEN/COMPLIC|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|13160||PC M/M HB CLINIC|2,010.00 PEMBINA COUNTY MEDICAL CENTER|14020|ADJ TISS XFER SCALP,EXTREM <10SQCM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|14020||PC STANDARD FEE SCHEDULE|1,431.00 PEMBINA COUNTY MEDICAL CENTER|14020|ADJ TISS XFER SCALP,EXTREM <10SQCM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|14020||PC M/M HB CLINIC|1,431.00 PEMBINA COUNTY MEDICAL CENTER|14021|ADJ TISS XFER SCALP,EXTREM 10.1-30|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|14021||PC STANDARD FEE SCHEDULE|1,803.00 PEMBINA COUNTY MEDICAL CENTER|14021|ADJ TISS XFER SCALP,EXTREM 10.1-30|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|14021||PC M/M HB CLINIC|1,803.00 PEMBINA COUNTY MEDICAL CENTER|14040|ADJ TISS XFER HEAD,FAC,HAND <10SQCM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|14040||PC STANDARD FEE SCHEDULE|1,589.00 PEMBINA COUNTY MEDICAL CENTER|14040|ADJ TISS XFER HEAD,FAC,HAND <10SQCM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|14040||PC M/M HB CLINIC|1,589.00 PEMBINA COUNTY MEDICAL CENTER|14060|ADJ TISS XFER LID,NOS,EAR <10SQCM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|14060||PC STANDARD FEE SCHEDULE|1,690.00 PEMBINA COUNTY MEDICAL CENTER|14060|ADJ TISS XFER LID,NOS,EAR <10SQCM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|14060||PC M/M HB CLINIC|1,690.00 PEMBINA COUNTY MEDICAL CENTER|15200|FULL THICK GRFT TRUNK <20 SQCM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|15200||PC STANDARD FEE SCHEDULE|1,682.00 PEMBINA COUNTY MEDICAL CENTER|15200|FULL THICK GRFT TRUNK <20 SQCM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|15200||PC M/M HB CLINIC|1,682.00 PEMBINA COUNTY MEDICAL CENTER|15201|FULL THICK GRFT TRUNK ADD 20 SQCM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|15201||PC STANDARD FEE SCHEDULE|197.00 PEMBINA COUNTY MEDICAL CENTER|15201|FULL THICK GRFT TRUNK ADD 20 SQCM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|15201||PC M/M HB CLINIC|197.00 PEMBINA COUNTY MEDICAL CENTER|15220|FULL THICK GRFT SCALP,ARM,LEG <20SQC|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|15220||PC STANDARD FEE SCHEDULE|1,545.00 PEMBINA COUNTY MEDICAL CENTER|15220|FULL THICK GRFT SCALP,ARM,LEG <20SQC|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|15220||PC M/M HB CLINIC|1,545.00 PEMBINA COUNTY MEDICAL CENTER|15240|FULL THICK GRFT HEAD,FAC,HAND <20SQC|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|15240||PC STANDARD FEE SCHEDULE|2,014.00 PEMBINA COUNTY MEDICAL CENTER|15240|FULL THICK GRFT HEAD,FAC,HAND <20SQC|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|15240||PC M/M HB CLINIC|2,014.00 PEMBINA COUNTY MEDICAL CENTER|15260|FULL THICK GRFT NOS,EAR,LID <20SQCM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|15260||PC STANDARD FEE SCHEDULE|2,159.00 PEMBINA COUNTY MEDICAL CENTER|15260|FULL THICK GRFT NOS,EAR,LID <20SQCM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|15260||PC M/M HB CLINIC|2,159.00 PEMBINA COUNTY MEDICAL CENTER|15734|MUSCLE-SKIN FLAP,TRUNK|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|15734||PC M/M HB CLINIC|3,154.00 PEMBINA COUNTY MEDICAL CENTER|15852|DRESSING CHANGE,NOT FOR BURN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|15852||PC STANDARD FEE SCHEDULE|115.00 PEMBINA COUNTY MEDICAL CENTER|15852|DRESSING CHANGE,NOT FOR BURN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|15852||PC M/M HB CLINIC|115.00 PEMBINA COUNTY MEDICAL CENTER|15940|EXC ISCH PRES ULC W PRIM CLOS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|15940||PC STANDARD FEE SCHEDULE|1,734.00 PEMBINA COUNTY MEDICAL CENTER|15940|EXC ISCH PRES ULC W PRIM CLOS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|15940||PC M/M HB CLINIC|1,734.00 PEMBINA COUNTY MEDICAL CENTER|16000|INITIAL RX BURN(S) 1ST DEGREE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|16000||PC STANDARD FEE SCHEDULE|114.00 PEMBINA COUNTY MEDICAL CENTER|16000|INITIAL RX BURN(S) 1ST DEGREE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|16000||PC M/M HB CLINIC|114.00 PEMBINA COUNTY MEDICAL CENTER|16020|DRESS/DEBRID SMALL BURN NO ANES|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|16020||PC STANDARD FEE SCHEDULE|136.00 PEMBINA COUNTY MEDICAL CENTER|16020|DRESS/DEBRID SMALL BURN NO ANES|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|16020||PC M/M HB CLINIC|136.00 PEMBINA COUNTY MEDICAL CENTER|16025|DRESS/DEBRID MED BURN NO ANESTH|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|16025||PC STANDARD FEE SCHEDULE|278.00 PEMBINA COUNTY MEDICAL CENTER|16025|DRESS/DEBRID MED BURN NO ANESTH|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|16025||PC M/M HB CLINIC|278.00 PEMBINA COUNTY MEDICAL CENTER|16030|DRESS/DEBRID LARGE BURN NO ANESTH|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|16030||PC STANDARD FEE SCHEDULE|332.00 PEMBINA COUNTY MEDICAL CENTER|16030|DRESS/DEBRID LARGE BURN NO ANESTH|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|16030||PC M/M HB CLINIC|332.00 PEMBINA COUNTY MEDICAL CENTER|17000|DESTRUC BENIGN/PREMAL,FIRST LESION|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|17000||PC STANDARD FEE SCHEDULE|141.00 PEMBINA COUNTY MEDICAL CENTER|17000|DESTRUC BENIGN/PREMAL,FIRST LESION|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|17000||PC M/M HB CLINIC|141.00 PEMBINA COUNTY MEDICAL CENTER|17110|DESTRUC LESION, UP TO 14 LESIONS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|17110||PC STANDARD FEE SCHEDULE|176.00 PEMBINA COUNTY MEDICAL CENTER|17110|DESTRUC LESION, UP TO 14 LESIONS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|17110||PC M/M HB CLINIC|176.00 PEMBINA COUNTY MEDICAL CENTER|19000|PUNC/ASPIR BREAST CYST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|19000||PC STANDARD FEE SCHEDULE|172.00 PEMBINA COUNTY MEDICAL CENTER|19000|PUNC/ASPIR BREAST CYST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|19000||PC M/M HB CLINIC|172.00 PEMBINA COUNTY MEDICAL CENTER|19001|PUCT/ASPIR BREAST CYST,EACH ADDN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|19001||PC STANDARD FEE SCHEDULE|54.00 PEMBINA COUNTY MEDICAL CENTER|19001|PUCT/ASPIR BREAST CYST,EACH ADDN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|19001||PC M/M HB CLINIC|54.00 PEMBINA COUNTY MEDICAL CENTER|19020|EXPLO/DRAIN BREAST ABSCESS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|19020||PC STANDARD FEE SCHEDULE|767.00 PEMBINA COUNTY MEDICAL CENTER|19020|EXPLO/DRAIN BREAST ABSCESS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|19020||PC M/M HB CLINIC|767.00 PEMBINA COUNTY MEDICAL CENTER|19100|BIOPSY OF BREAST, NEEDLE CORE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|19100||PC STANDARD FEE SCHEDULE|172.00 PEMBINA COUNTY MEDICAL CENTER|19100|BIOPSY OF BREAST, NEEDLE CORE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|19100||PC M/M HB CLINIC|172.00 PEMBINA COUNTY MEDICAL CENTER|19101|BIOPSY OF BREAST, INCISIONAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|19101||PC STANDARD FEE SCHEDULE|550.00 PEMBINA COUNTY MEDICAL CENTER|19101|BIOPSY OF BREAST, INCISIONAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|19101||PC M/M HB CLINIC|550.00 PEMBINA COUNTY MEDICAL CENTER|19102|BX OF BREAST, NEEDLE CORE, IMAGE GUIDE||19102||PC STANDARD FEE SCHEDULE|237.00 PEMBINA COUNTY MEDICAL CENTER|19102|BX OF BREAST, NEEDLE CORE, IMAGE GUIDE||19102||PC M/M HB CLINIC|237.00 PEMBINA COUNTY MEDICAL CENTER|19103|BX OF BREAST,VACUUM ASST,IMAGE GUIDE||19103||PC STANDARD FEE SCHEDULE|444.00 PEMBINA COUNTY MEDICAL CENTER|19103|BX OF BREAST,VACUUM ASST,IMAGE GUIDE||19103||PC M/M HB CLINIC|444.00 PEMBINA COUNTY MEDICAL CENTER|19120|EXCISE BREAST CYST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|19120||PC STANDARD FEE SCHEDULE|1,026.00 PEMBINA COUNTY MEDICAL CENTER|19120|EXCISE BREAST CYST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|19120||PC M/M HB CLINIC|1,026.00 PEMBINA COUNTY MEDICAL CENTER|19125|EXCISE BREAST LES W XRAY MARKER|PROFESSIONAL FEES - OPERATING ROOM [0975]|19125||PC STANDARD FEE SCHEDULE|1,139.00 PEMBINA COUNTY MEDICAL CENTER|19125|EXCISE BREAST LES W XRAY MARKER|PROFESSIONAL FEES - OPERATING ROOM [0975]|19125||PC M/M HB CLINIC|1,139.00 PEMBINA COUNTY MEDICAL CENTER|19290|PLACE NEEDLE WIRE, BREAST|PROFESSIONAL FEES - OPERATING ROOM [0975]|19290||PC STANDARD FEE SCHEDULE|157.00 PEMBINA COUNTY MEDICAL CENTER|19290|PLACE NEEDLE WIRE, BREAST|PROFESSIONAL FEES - OPERATING ROOM [0975]|19290||PC M/M HB CLINIC|157.00 PEMBINA COUNTY MEDICAL CENTER|19295|BX OF BREAST,PLC METAL CLIP W/IMAGING||19295||PC STANDARD FEE SCHEDULE|227.00 PEMBINA COUNTY MEDICAL CENTER|19295|BX OF BREAST,PLC METAL CLIP W/IMAGING||19295||PC M/M HB CLINIC|227.00 PEMBINA COUNTY MEDICAL CENTER|20103|EXPLORE WOUND,EXTREMITY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|20103||PC STANDARD FEE SCHEDULE|866.00 PEMBINA COUNTY MEDICAL CENTER|20103|EXPLORE WOUND,EXTREMITY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|20103||PC M/M HB CLINIC|866.00 PEMBINA COUNTY MEDICAL CENTER|20206|NEEDLE BIOPSY,MUSCLE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|20206||PC STANDARD FEE SCHEDULE|147.00 PEMBINA COUNTY MEDICAL CENTER|20206|NEEDLE BIOPSY,MUSCLE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|20206||PC M/M HB CLINIC|147.00 PEMBINA COUNTY MEDICAL CENTER|20520|REMOVAL OF FOREIGN BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|20520||PC STANDARD FEE SCHEDULE|366.00 PEMBINA COUNTY MEDICAL CENTER|20520|REMOVAL OF FOREIGN BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|20520||PC M/M HB CLINIC|366.00 PEMBINA COUNTY MEDICAL CENTER|20525|REMOVAL OF FOREIGN BODY DEEP/COMPLIC|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|20525||PC STANDARD FEE SCHEDULE|620.00 PEMBINA COUNTY MEDICAL CENTER|20525|REMOVAL OF FOREIGN BODY DEEP/COMPLIC|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|20525||PC M/M HB CLINIC|620.00 PEMBINA COUNTY MEDICAL CENTER|20550|INJECT TENDON SHEATH/LIGAMENT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|20550||PC STANDARD FEE SCHEDULE|102.00 PEMBINA COUNTY MEDICAL CENTER|20550|INJECT TENDON SHEATH/LIGAMENT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|20550||PC M/M HB CLINIC|102.00 PEMBINA COUNTY MEDICAL CENTER|20551|INJECT TENDON ORIGIN/INSERT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|20551||PC M/M HB CLINIC|93.00 PEMBINA COUNTY MEDICAL CENTER|20552|INJECT TRIGGER POINT, 1 OR 2|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|20552||PC STANDARD FEE SCHEDULE|93.00 PEMBINA COUNTY MEDICAL CENTER|20552|INJECT TRIGGER POINT, 1 OR 2|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|20552||PC M/M HB CLINIC|93.00 PEMBINA COUNTY MEDICAL CENTER|20553|INJECT TRIGGER POINTS, > 3|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|20553||PC M/M HB CLINIC|104.00 PEMBINA COUNTY MEDICAL CENTER|20610|ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|20610||PC STANDARD FEE SCHEDULE|114.00 PEMBINA COUNTY MEDICAL CENTER|20610|ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|20610||PC M/M HB CLINIC|114.00 PEMBINA COUNTY MEDICAL CENTER|20612|ASPIRAT/INJECTION GANGLION CYST(S)|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|20612||PC STANDARD FEE SCHEDULE|103.00 PEMBINA COUNTY MEDICAL CENTER|20612|ASPIRAT/INJECTION GANGLION CYST(S)|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|20612||PC M/M HB CLINIC|103.00 PEMBINA COUNTY MEDICAL CENTER|21030|EXCISION,BENIGN TUMOR,MAXILLA/ZYGOMA|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|21030||PC STANDARD FEE SCHEDULE|1,050.00 PEMBINA COUNTY MEDICAL CENTER|21030|EXCISION,BENIGN TUMOR,MAXILLA/ZYGOMA|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|21030||PC M/M HB CLINIC|1,050.00 PEMBINA COUNTY MEDICAL CENTER|21310|CLOSED RX NOSE FRACTURE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|21310||PC STANDARD FEE SCHEDULE|69.00 PEMBINA COUNTY MEDICAL CENTER|21310|CLOSED RX NOSE FRACTURE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|21310||PC M/M HB CLINIC|69.00 PEMBINA COUNTY MEDICAL CENTER|21501|I&D DEEP ABSC/HEMATOMA NECK/CHEST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|21501||PC STANDARD FEE SCHEDULE|813.00 PEMBINA COUNTY MEDICAL CENTER|21501|I&D DEEP ABSC/HEMATOMA NECK/CHEST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|21501||PC M/M HB CLINIC|813.00 PEMBINA COUNTY MEDICAL CENTER|21555|EXCISE LESN NECK/CHEST,SUBCUTAN|PROFESSIONAL FEES - OPERATING ROOM [0975]|21555||PC STANDARD FEE SCHEDULE|772.00 PEMBINA COUNTY MEDICAL CENTER|21555|EXCISE LESN NECK/CHEST,SUBCUTAN|PROFESSIONAL FEES - OPERATING ROOM [0975]|21555||PC M/M HB CLINIC|772.00 PEMBINA COUNTY MEDICAL CENTER|21556|EXCISE LESN NECK/CHEST,DEEP|PROFESSIONAL FEES - OPERATING ROOM [0975]|21556||PC STANDARD FEE SCHEDULE|1,331.00 PEMBINA COUNTY MEDICAL CENTER|21556|EXCISE LESN NECK/CHEST,DEEP|PROFESSIONAL FEES - OPERATING ROOM [0975]|21556||PC M/M HB CLINIC|1,331.00 PEMBINA COUNTY MEDICAL CENTER|21930|EXCISE LESION,BACK OR FLANK|PROFESSIONAL FEES - OPERATING ROOM [0975]|21930||PC STANDARD FEE SCHEDULE|916.00 PEMBINA COUNTY MEDICAL CENTER|21930|EXCISE LESION,BACK OR FLANK|PROFESSIONAL FEES - OPERATING ROOM [0975]|21930||PC M/M HB CLINIC|916.00 PEMBINA COUNTY MEDICAL CENTER|23065|EXPLOR INFECT A-C/S-C JT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|23065||PC STANDARD FEE SCHEDULE|424.00 PEMBINA COUNTY MEDICAL CENTER|23065|EXPLOR INFECT A-C/S-C JT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|23065||PC M/M HB CLINIC|424.00 PEMBINA COUNTY MEDICAL CENTER|23076|EXCIS SUBCUT SHLDR TUMOR|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|23076||PC STANDARD FEE SCHEDULE|818.00 PEMBINA COUNTY MEDICAL CENTER|23076|EXCIS SUBCUT SHLDR TUMOR|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|23076||PC M/M HB CLINIC|818.00 PEMBINA COUNTY MEDICAL CENTER|23500|CLOSED RX CLAVICLE FRACTURE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|23500||PC STANDARD FEE SCHEDULE|552.00 PEMBINA COUNTY MEDICAL CENTER|23500|CLOSED RX CLAVICLE FRACTURE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|23500||PC M/M HB CLINIC|552.00 PEMBINA COUNTY MEDICAL CENTER|23505|CLOSED RX CLAVICLE FX,MANIPULATN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|23505||PC STANDARD FEE SCHEDULE|886.00 PEMBINA COUNTY MEDICAL CENTER|23505|CLOSED RX CLAVICLE FX,MANIPULATN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|23505||PC M/M HB CLINIC|886.00 PEMBINA COUNTY MEDICAL CENTER|23570|CLOSED RX SCAPULA FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|23570||PC STANDARD FEE SCHEDULE|583.00 PEMBINA COUNTY MEDICAL CENTER|23570|CLOSED RX SCAPULA FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|23570||PC M/M HB CLINIC|583.00 PEMBINA COUNTY MEDICAL CENTER|23650|CLOSED RX SHLDR DISLOCATION|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|23650||PC STANDARD FEE SCHEDULE|727.00 PEMBINA COUNTY MEDICAL CENTER|23650|CLOSED RX SHLDR DISLOCATION|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|23650||PC M/M HB CLINIC|727.00 PEMBINA COUNTY MEDICAL CENTER|23655|CLOSED RX SHLDR DISLOC,ANESTHESIA|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|23655||PC STANDARD FEE SCHEDULE|1,000.00 PEMBINA COUNTY MEDICAL CENTER|23655|CLOSED RX SHLDR DISLOC,ANESTHESIA|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|23655||PC M/M HB CLINIC|1,000.00 PEMBINA COUNTY MEDICAL CENTER|23675|CLOSED RX SHLDR DISLOC,PROX HUM FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|23675||PC STANDARD FEE SCHEDULE|1,245.00 PEMBINA COUNTY MEDICAL CENTER|23675|CLOSED RX SHLDR DISLOC,PROX HUM FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|23675||PC M/M HB CLINIC|1,245.00 PEMBINA COUNTY MEDICAL CENTER|23930|INCIS/DRAIN ARM,DEEP ABSC/HEMATOMA|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|23930||PC STANDARD FEE SCHEDULE|539.00 PEMBINA COUNTY MEDICAL CENTER|23930|INCIS/DRAIN ARM,DEEP ABSC/HEMATOMA|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|23930||PC M/M HB CLINIC|539.00 PEMBINA COUNTY MEDICAL CENTER|23931|INCIS/DRAIN ARM/ELBOW INFECT BURSA|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|23931||PC STANDARD FEE SCHEDULE|401.00 PEMBINA COUNTY MEDICAL CENTER|23931|INCIS/DRAIN ARM/ELBOW INFECT BURSA|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|23931||PC M/M HB CLINIC|401.00 PEMBINA COUNTY MEDICAL CENTER|24075|EXCIS TUMOR,SOFT TISS UP ARM/ELBOW,SUBQ|PROFESSIONAL FEES - OPERATING ROOM [0975]|24075||PC STANDARD FEE SCHEDULE|825.00 PEMBINA COUNTY MEDICAL CENTER|24075|EXCIS TUMOR,SOFT TISS UP ARM/ELBOW,SUBQ|PROFESSIONAL FEES - OPERATING ROOM [0975]|24075||PC M/M HB CLINIC|825.00 PEMBINA COUNTY MEDICAL CENTER|24200|REMOVAL ARM/ELBOW F.B.,SUPERFICIAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|24200||PC STANDARD FEE SCHEDULE|168.00 PEMBINA COUNTY MEDICAL CENTER|24200|REMOVAL ARM/ELBOW F.B.,SUPERFICIAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|24200||PC M/M HB CLINIC|168.00 PEMBINA COUNTY MEDICAL CENTER|24500|CLOSED RX MID HUMERUS FRACTURE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|24500||PC STANDARD FEE SCHEDULE|818.00 PEMBINA COUNTY MEDICAL CENTER|24500|CLOSED RX MID HUMERUS FRACTURE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|24500||PC M/M HB CLINIC|818.00 PEMBINA COUNTY MEDICAL CENTER|24530|CLOSED RX HUMERAL SUPRACONDYLAR FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|24530||PC STANDARD FEE SCHEDULE|864.00 PEMBINA COUNTY MEDICAL CENTER|24530|CLOSED RX HUMERAL SUPRACONDYLAR FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|24530||PC M/M HB CLINIC|864.00 PEMBINA COUNTY MEDICAL CENTER|24560|CLOSED RX HUMER EPICONDYLR FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|24560||PC STANDARD FEE SCHEDULE|726.00 PEMBINA COUNTY MEDICAL CENTER|24560|CLOSED RX HUMER EPICONDYLR FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|24560||PC M/M HB CLINIC|726.00 PEMBINA COUNTY MEDICAL CENTER|24576|CLOSED RX HUMER CONDYLR FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|24576||PC STANDARD FEE SCHEDULE|770.00 PEMBINA COUNTY MEDICAL CENTER|24576|CLOSED RX HUMER CONDYLR FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|24576||PC M/M HB CLINIC|770.00 PEMBINA COUNTY MEDICAL CENTER|24600|CLOSED RX ELBOW DISLOCATION|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|24600||PC STANDARD FEE SCHEDULE|840.00 PEMBINA COUNTY MEDICAL CENTER|24600|CLOSED RX ELBOW DISLOCATION|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|24600||PC M/M HB CLINIC|840.00 PEMBINA COUNTY MEDICAL CENTER|24640|CLOSED RX RADIAL HEAD DISLOC,CHILD|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|24640||PC STANDARD FEE SCHEDULE|241.00 PEMBINA COUNTY MEDICAL CENTER|24640|CLOSED RX RADIAL HEAD DISLOC,CHILD|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|24640||PC M/M HB CLINIC|241.00 PEMBINA COUNTY MEDICAL CENTER|25075|EXCIS TUMOR,SOFT TISS FOREARM/WRIST,SUBQ|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|25075||PC STANDARD FEE SCHEDULE|793.00 PEMBINA COUNTY MEDICAL CENTER|25075|EXCIS TUMOR,SOFT TISS FOREARM/WRIST,SUBQ|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|25075||PC M/M HB CLINIC|793.00 PEMBINA COUNTY MEDICAL CENTER|25111|EXCIS PRIMARY GANGLION WRIST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|25111||PC STANDARD FEE SCHEDULE|800.00 PEMBINA COUNTY MEDICAL CENTER|25111|EXCIS PRIMARY GANGLION WRIST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|25111||PC M/M HB CLINIC|800.00 PEMBINA COUNTY MEDICAL CENTER|25248|REMOVE FOREARM/WRIST FOREIGN BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|25248||PC STANDARD FEE SCHEDULE|1,027.00 PEMBINA COUNTY MEDICAL CENTER|25248|REMOVE FOREARM/WRIST FOREIGN BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|25248||PC M/M HB CLINIC|1,027.00 PEMBINA COUNTY MEDICAL CENTER|25500|CLOSED RX RADIAL SHAFT FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|25500||PC STANDARD FEE SCHEDULE|629.00 PEMBINA COUNTY MEDICAL CENTER|25500|CLOSED RX RADIAL SHAFT FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|25500||PC M/M HB CLINIC|629.00 PEMBINA COUNTY MEDICAL CENTER|25530|CLOSED RX ULNA SHAFT FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|25530||PC STANDARD FEE SCHEDULE|597.00 PEMBINA COUNTY MEDICAL CENTER|25530|CLOSED RX ULNA SHAFT FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|25530||PC M/M HB CLINIC|597.00 PEMBINA COUNTY MEDICAL CENTER|25560|CLOSED RX RAD/ULNA SHAFT FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|25560||PC STANDARD FEE SCHEDULE|634.00 PEMBINA COUNTY MEDICAL CENTER|25560|CLOSED RX RAD/ULNA SHAFT FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|25560||PC M/M HB CLINIC|634.00 PEMBINA COUNTY MEDICAL CENTER|25600|CLOSED RX DIST RAD/ULNA FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|25600||PC STANDARD FEE SCHEDULE|785.00 PEMBINA COUNTY MEDICAL CENTER|25600|CLOSED RX DIST RAD/ULNA FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|25600||PC M/M HB CLINIC|785.00 PEMBINA COUNTY MEDICAL CENTER|25622|CLOSED RX NAVICULAR FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|25622||PC STANDARD FEE SCHEDULE|700.00 PEMBINA COUNTY MEDICAL CENTER|25622|CLOSED RX NAVICULAR FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|25622||PC M/M HB CLINIC|700.00 PEMBINA COUNTY MEDICAL CENTER|25680|CLOSED RX NAVIC/LUNATE FX/DISLOC|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|25680||PC STANDARD FEE SCHEDULE|1,194.00 PEMBINA COUNTY MEDICAL CENTER|25680|CLOSED RX NAVIC/LUNATE FX/DISLOC|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|25680||PC M/M HB CLINIC|1,194.00 PEMBINA COUNTY MEDICAL CENTER|26010|DRAIN FINGER ABSCESS,SIMPLE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|26010||PC STANDARD FEE SCHEDULE|350.00 PEMBINA COUNTY MEDICAL CENTER|26010|DRAIN FINGER ABSCESS,SIMPLE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|26010||PC M/M HB CLINIC|350.00 PEMBINA COUNTY MEDICAL CENTER|26011|DRAIN FINGER ABSCESS,COMPLICATED|PROFESSIONAL FEES - OPERATING ROOM [0975]|26011||PC STANDARD FEE SCHEDULE|460.00 PEMBINA COUNTY MEDICAL CENTER|26011|DRAIN FINGER ABSCESS,COMPLICATED|PROFESSIONAL FEES - OPERATING ROOM [0975]|26011||PC M/M HB CLINIC|460.00 PEMBINA COUNTY MEDICAL CENTER|26160|EXCIS TENDON SHEATH LESION, HAND/FINGER|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|26160||PC STANDARD FEE SCHEDULE|833.00 PEMBINA COUNTY MEDICAL CENTER|26160|EXCIS TENDON SHEATH LESION, HAND/FINGER|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|26160||PC M/M HB CLINIC|833.00 PEMBINA COUNTY MEDICAL CENTER|26600|CLOSED RX METACARPAL FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|26600||PC STANDARD FEE SCHEDULE|700.00 PEMBINA COUNTY MEDICAL CENTER|26600|CLOSED RX METACARPAL FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|26600||PC M/M HB CLINIC|700.00 PEMBINA COUNTY MEDICAL CENTER|26605|CLOSED RX METACARPAL FX,MANIP|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|26605||PC STANDARD FEE SCHEDULE|737.00 PEMBINA COUNTY MEDICAL CENTER|26605|CLOSED RX METACARPAL FX,MANIP|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|26605||PC M/M HB CLINIC|737.00 PEMBINA COUNTY MEDICAL CENTER|26607|CLOSED RX METACARP FX,W/MANIP,W/EXT FIX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|26607||PC STANDARD FEE SCHEDULE|1,138.00 PEMBINA COUNTY MEDICAL CENTER|26607|CLOSED RX METACARP FX,W/MANIP,W/EXT FIX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|26607||PC M/M HB CLINIC|1,138.00 PEMBINA COUNTY MEDICAL CENTER|26641|TREAT THUMB DISLOC,MANIPULATN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|26641||PC STANDARD FEE SCHEDULE|840.00 PEMBINA COUNTY MEDICAL CENTER|26641|TREAT THUMB DISLOC,MANIPULATN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|26641||PC M/M HB CLINIC|840.00 PEMBINA COUNTY MEDICAL CENTER|26645|TREAT THUMB FX/DISLOC,MANIP|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|26645||PC STANDARD FEE SCHEDULE|975.00 PEMBINA COUNTY MEDICAL CENTER|26645|TREAT THUMB FX/DISLOC,MANIP|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|26645||PC M/M HB CLINIC|975.00 PEMBINA COUNTY MEDICAL CENTER|26720|CLOSE RX PROX/MID FING SHFT FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|26720||PC STANDARD FEE SCHEDULE|467.00 PEMBINA COUNTY MEDICAL CENTER|26720|CLOSE RX PROX/MID FING SHFT FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|26720||PC M/M HB CLINIC|467.00 PEMBINA COUNTY MEDICAL CENTER|26750|CLOSE RX DIST FINGR FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|26750||PC STANDARD FEE SCHEDULE|467.00 PEMBINA COUNTY MEDICAL CENTER|26750|CLOSE RX DIST FINGR FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|26750||PC M/M HB CLINIC|467.00 PEMBINA COUNTY MEDICAL CENTER|26755|CLOSE RX DIST FINGR FX,MANIPULATN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|26755||PC STANDARD FEE SCHEDULE|687.00 PEMBINA COUNTY MEDICAL CENTER|26755|CLOSE RX DIST FINGR FX,MANIPULATN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|26755||PC M/M HB CLINIC|687.00 PEMBINA COUNTY MEDICAL CENTER|26765|OPEN RX DIST FINGR FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|26765||PC STANDARD FEE SCHEDULE|1,249.00 PEMBINA COUNTY MEDICAL CENTER|26765|OPEN RX DIST FINGR FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|26765||PC M/M HB CLINIC|1,249.00 PEMBINA COUNTY MEDICAL CENTER|26770|CLOSED RX IP JT DISLOCATION|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|26770||PC STANDARD FEE SCHEDULE|645.00 PEMBINA COUNTY MEDICAL CENTER|26770|CLOSED RX IP JT DISLOCATION|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|26770||PC M/M HB CLINIC|645.00 PEMBINA COUNTY MEDICAL CENTER|26952|AMPUTATION FINGER/THUMB+FLAPS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|26952||PC STANDARD FEE SCHEDULE|1,595.00 PEMBINA COUNTY MEDICAL CENTER|26952|AMPUTATION FINGER/THUMB+FLAPS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|26952||PC M/M HB CLINIC|1,595.00 PEMBINA COUNTY MEDICAL CENTER|27301|INCIS/DRAIN THIGH/KNEE ABSCESS,DEEP|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27301||PC STANDARD FEE SCHEDULE|1,249.00 PEMBINA COUNTY MEDICAL CENTER|27301|INCIS/DRAIN THIGH/KNEE ABSCESS,DEEP|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27301||PC M/M HB CLINIC|1,249.00 PEMBINA COUNTY MEDICAL CENTER|27327|REMV THIGH/KNEE TUMOR,SUBCUTANEOUS|PROFESSIONAL FEES - OPERATING ROOM [0975]|27327||PC STANDARD FEE SCHEDULE|785.00 PEMBINA COUNTY MEDICAL CENTER|27327|REMV THIGH/KNEE TUMOR,SUBCUTANEOUS|PROFESSIONAL FEES - OPERATING ROOM [0975]|27327||PC M/M HB CLINIC|785.00 PEMBINA COUNTY MEDICAL CENTER|27345|REMOVAL SYNOVIAL CYST,KNEE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27345||PC STANDARD FEE SCHEDULE|1,196.00 PEMBINA COUNTY MEDICAL CENTER|27345|REMOVAL SYNOVIAL CYST,KNEE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27345||PC M/M HB CLINIC|1,196.00 PEMBINA COUNTY MEDICAL CENTER|27372|REMV FOREIGN BODY,KNEE/THIGH,DEEP|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27372||PC STANDARD FEE SCHEDULE|1,008.00 PEMBINA COUNTY MEDICAL CENTER|27372|REMV FOREIGN BODY,KNEE/THIGH,DEEP|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27372||PC M/M HB CLINIC|1,008.00 PEMBINA COUNTY MEDICAL CENTER|27520|CLOSED RX PATELLA FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27520||PC STANDARD FEE SCHEDULE|745.00 PEMBINA COUNTY MEDICAL CENTER|27520|CLOSED RX PATELLA FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27520||PC M/M HB CLINIC|745.00 PEMBINA COUNTY MEDICAL CENTER|27560|CLOSED RX KNEECAP DISLOCATN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27560||PC STANDARD FEE SCHEDULE|848.00 PEMBINA COUNTY MEDICAL CENTER|27560|CLOSED RX KNEECAP DISLOCATN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27560||PC M/M HB CLINIC|848.00 PEMBINA COUNTY MEDICAL CENTER|27562|CLOSED RX KNEECAP DISLOC+ANESTH|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27562||PC STANDARD FEE SCHEDULE|1,205.00 PEMBINA COUNTY MEDICAL CENTER|27562|CLOSED RX KNEECAP DISLOC+ANESTH|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27562||PC M/M HB CLINIC|1,205.00 PEMBINA COUNTY MEDICAL CENTER|27590|AMPUTATE THIGH,THRU FEMUR|PROFESSIONAL FEES - OPERATING ROOM [0975]|27590||PC STANDARD FEE SCHEDULE|2,031.00 PEMBINA COUNTY MEDICAL CENTER|27590|AMPUTATE THIGH,THRU FEMUR|PROFESSIONAL FEES - OPERATING ROOM [0975]|27590||PC M/M HB CLINIC|2,031.00 PEMBINA COUNTY MEDICAL CENTER|27603|DRAIN LOWER LEG DEEP ABSC/HEMATOMA|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27603||PC STANDARD FEE SCHEDULE|982.00 PEMBINA COUNTY MEDICAL CENTER|27603|DRAIN LOWER LEG DEEP ABSC/HEMATOMA|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27603||PC M/M HB CLINIC|982.00 PEMBINA COUNTY MEDICAL CENTER|27618|RESEC TUMOR LOWER LEG,SUBCUT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27618||PC STANDARD FEE SCHEDULE|764.00 PEMBINA COUNTY MEDICAL CENTER|27618|RESEC TUMOR LOWER LEG,SUBCUT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27618||PC M/M HB CLINIC|764.00 PEMBINA COUNTY MEDICAL CENTER|27630|EXCIS LESN TENDON SHEALTH LEG/ANKLE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27630||PC STANDARD FEE SCHEDULE|913.00 PEMBINA COUNTY MEDICAL CENTER|27630|EXCIS LESN TENDON SHEALTH LEG/ANKLE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27630||PC M/M HB CLINIC|913.00 PEMBINA COUNTY MEDICAL CENTER|27705|OSTEOTOMY TIBIA|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27705||PC STANDARD FEE SCHEDULE|1,887.00 PEMBINA COUNTY MEDICAL CENTER|27705|OSTEOTOMY TIBIA|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27705||PC M/M HB CLINIC|1,887.00 PEMBINA COUNTY MEDICAL CENTER|27750|CLOSED RX TIBIA SHAFT FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27750||PC STANDARD FEE SCHEDULE|800.00 PEMBINA COUNTY MEDICAL CENTER|27750|CLOSED RX TIBIA SHAFT FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27750||PC M/M HB CLINIC|800.00 PEMBINA COUNTY MEDICAL CENTER|27752|CLOSED RX TIBIA SHAFT FX,MANIPULATN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27752||PC STANDARD FEE SCHEDULE|1,239.00 PEMBINA COUNTY MEDICAL CENTER|27752|CLOSED RX TIBIA SHAFT FX,MANIPULATN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27752||PC M/M HB CLINIC|1,239.00 PEMBINA COUNTY MEDICAL CENTER|27760|CLOSED RX MED MALLEOLUS FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27760||PC STANDARD FEE SCHEDULE|770.00 PEMBINA COUNTY MEDICAL CENTER|27760|CLOSED RX MED MALLEOLUS FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27760||PC M/M HB CLINIC|770.00 PEMBINA COUNTY MEDICAL CENTER|27780|CLOSED RX PROX/SHAFT FIBULA FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27780||PC STANDARD FEE SCHEDULE|705.00 PEMBINA COUNTY MEDICAL CENTER|27780|CLOSED RX PROX/SHAFT FIBULA FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27780||PC M/M HB CLINIC|705.00 PEMBINA COUNTY MEDICAL CENTER|27786|CLOSED RX DIST FIBULA FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27786||PC STANDARD FEE SCHEDULE|723.00 PEMBINA COUNTY MEDICAL CENTER|27786|CLOSED RX DIST FIBULA FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27786||PC M/M HB CLINIC|723.00 PEMBINA COUNTY MEDICAL CENTER|27808|pr CLOSED RX BIMALLEOLAR FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27808||PC STANDARD FEE SCHEDULE|760.00 PEMBINA COUNTY MEDICAL CENTER|27808|pr CLOSED RX BIMALLEOLAR FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27808||PC M/M HB CLINIC|760.00 PEMBINA COUNTY MEDICAL CENTER|27824|CLOSED RX WEIGHT BEAR DIST TIBIA|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27824||PC STANDARD FEE SCHEDULE|764.00 PEMBINA COUNTY MEDICAL CENTER|27824|CLOSED RX WEIGHT BEAR DIST TIBIA|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27824||PC M/M HB CLINIC|764.00 PEMBINA COUNTY MEDICAL CENTER|28008|INCISION OF FOOT/TOE FASCIA|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|28008||PC STANDARD FEE SCHEDULE|728.00 PEMBINA COUNTY MEDICAL CENTER|28008|INCISION OF FOOT/TOE FASCIA|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|28008||PC M/M HB CLINIC|728.00 PEMBINA COUNTY MEDICAL CENTER|28020|EXPLOR TARSAL/TARSOMETATAR JT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|28020||PC STANDARD FEE SCHEDULE|903.00 PEMBINA COUNTY MEDICAL CENTER|28020|EXPLOR TARSAL/TARSOMETATAR JT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|28020||PC M/M HB CLINIC|903.00 PEMBINA COUNTY MEDICAL CENTER|28092|EXCIS TENDN/CAPSULE LESN,TOES|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|28092||PC STANDARD FEE SCHEDULE|678.00 PEMBINA COUNTY MEDICAL CENTER|28092|EXCIS TENDN/CAPSULE LESN,TOES|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|28092||PC M/M HB CLINIC|678.00 PEMBINA COUNTY MEDICAL CENTER|28122|PART REMV OTHR TARSAL/METATARSAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|28122||PC STANDARD FEE SCHEDULE|1,099.00 PEMBINA COUNTY MEDICAL CENTER|28122|PART REMV OTHR TARSAL/METATARSAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|28122||PC M/M HB CLINIC|1,099.00 PEMBINA COUNTY MEDICAL CENTER|28190|REMV FOOT FOREIGN BODY,SUBCUTANEOUS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|28190||PC STANDARD FEE SCHEDULE|334.00 PEMBINA COUNTY MEDICAL CENTER|28190|REMV FOOT FOREIGN BODY,SUBCUTANEOUS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|28190||PC M/M HB CLINIC|334.00 PEMBINA COUNTY MEDICAL CENTER|28192|REMV FOOT FOREIGN BODY,DEEP|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|28192||PC STANDARD FEE SCHEDULE|788.00 PEMBINA COUNTY MEDICAL CENTER|28192|REMV FOOT FOREIGN BODY,DEEP|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|28192||PC M/M HB CLINIC|788.00 PEMBINA COUNTY MEDICAL CENTER|28450|CLOSED RX TARSAL FX,EACH|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|28450||PC STANDARD FEE SCHEDULE|489.00 PEMBINA COUNTY MEDICAL CENTER|28450|CLOSED RX TARSAL FX,EACH|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|28450||PC M/M HB CLINIC|489.00 PEMBINA COUNTY MEDICAL CENTER|28470|CLOSED RX METATARSAL FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|28470||PC STANDARD FEE SCHEDULE|523.00 PEMBINA COUNTY MEDICAL CENTER|28470|CLOSED RX METATARSAL FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|28470||PC M/M HB CLINIC|523.00 PEMBINA COUNTY MEDICAL CENTER|28490|CLOSED RX BIG TOE FRACTURE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|28490||PC STANDARD FEE SCHEDULE|321.00 PEMBINA COUNTY MEDICAL CENTER|28490|CLOSED RX BIG TOE FRACTURE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|28490||PC M/M HB CLINIC|321.00 PEMBINA COUNTY MEDICAL CENTER|28510|CLOSED RX TOE FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|28510||PC STANDARD FEE SCHEDULE|307.00 PEMBINA COUNTY MEDICAL CENTER|28510|CLOSED RX TOE FX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|28510||PC M/M HB CLINIC|307.00 PEMBINA COUNTY MEDICAL CENTER|28660|CLOSED RX I-P JT,TOE DISLOCATION|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|28660||PC STANDARD FEE SCHEDULE|224.00 PEMBINA COUNTY MEDICAL CENTER|28660|CLOSED RX I-P JT,TOE DISLOCATION|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|28660||PC M/M HB CLINIC|224.00 PEMBINA COUNTY MEDICAL CENTER|28810|AMPUTATION METATARSAL+TOE,SINGLE|PROFESSIONAL FEES - OPERATING ROOM [0975]|28810||PC STANDARD FEE SCHEDULE|1,099.00 PEMBINA COUNTY MEDICAL CENTER|28810|AMPUTATION METATARSAL+TOE,SINGLE|PROFESSIONAL FEES - OPERATING ROOM [0975]|28810||PC M/M HB CLINIC|1,099.00 PEMBINA COUNTY MEDICAL CENTER|29065|APPLY LONG ARM CAST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|29065||PC STANDARD FEE SCHEDULE|173.00 PEMBINA COUNTY MEDICAL CENTER|29065|APPLY LONG ARM CAST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|29065||PC M/M HB CLINIC|173.00 PEMBINA COUNTY MEDICAL CENTER|29075|APPLY FOREARM CAST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|29075||PC STANDARD FEE SCHEDULE|157.00 PEMBINA COUNTY MEDICAL CENTER|29075|APPLY FOREARM CAST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|29075||PC M/M HB CLINIC|157.00 PEMBINA COUNTY MEDICAL CENTER|29105|APPLY LONG ARM SPLINT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|29105||PC STANDARD FEE SCHEDULE|150.00 PEMBINA COUNTY MEDICAL CENTER|29105|APPLY LONG ARM SPLINT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|29105||PC M/M HB CLINIC|150.00 PEMBINA COUNTY MEDICAL CENTER|29125|APPLY FOREARM SPLINT,STATIC|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|29125||PC STANDARD FEE SCHEDULE|101.00 PEMBINA COUNTY MEDICAL CENTER|29125|APPLY FOREARM SPLINT,STATIC|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|29125||PC M/M HB CLINIC|101.00 PEMBINA COUNTY MEDICAL CENTER|29130|APPLY FINGER SPLINT,STATIC|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|29130||PC STANDARD FEE SCHEDULE|70.00 PEMBINA COUNTY MEDICAL CENTER|29130|APPLY FINGER SPLINT,STATIC|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|29130||PC M/M HB CLINIC|70.00 PEMBINA COUNTY MEDICAL CENTER|29240|STRAPPING OF SHOULDER|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|29240||PC STANDARD FEE SCHEDULE|109.00 PEMBINA COUNTY MEDICAL CENTER|29240|STRAPPING OF SHOULDER|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|29240||PC M/M HB CLINIC|109.00 PEMBINA COUNTY MEDICAL CENTER|29260|STRAPPING OF ELBOW OR WRIST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|29260||PC STANDARD FEE SCHEDULE|95.00 PEMBINA COUNTY MEDICAL CENTER|29260|STRAPPING OF ELBOW OR WRIST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|29260||PC M/M HB CLINIC|95.00 PEMBINA COUNTY MEDICAL CENTER|29280|STRAPPING OF HAND OR FINGER|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|29280||PC STANDARD FEE SCHEDULE|91.00 PEMBINA COUNTY MEDICAL CENTER|29280|STRAPPING OF HAND OR FINGER|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|29280||PC M/M HB CLINIC|91.00 PEMBINA COUNTY MEDICAL CENTER|29345|APPLY LONG LEG CAST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|29345||PC STANDARD FEE SCHEDULE|252.00 PEMBINA COUNTY MEDICAL CENTER|29345|APPLY LONG LEG CAST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|29345||PC M/M HB CLINIC|252.00 PEMBINA COUNTY MEDICAL CENTER|29405|APPLY SHORT LEG CAST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|29405||PC STANDARD FEE SCHEDULE|151.00 PEMBINA COUNTY MEDICAL CENTER|29405|APPLY SHORT LEG CAST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|29405||PC M/M HB CLINIC|151.00 PEMBINA COUNTY MEDICAL CENTER|29425|APPLY SHORT LEG CAST,WALKER|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|29425||PC STANDARD FEE SCHEDULE|142.00 PEMBINA COUNTY MEDICAL CENTER|29425|APPLY SHORT LEG CAST,WALKER|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|29425||PC M/M HB CLINIC|142.00 PEMBINA COUNTY MEDICAL CENTER|29515|APPLY LOWER LEG SPLINT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|29515||PC STANDARD FEE SCHEDULE|126.00 PEMBINA COUNTY MEDICAL CENTER|29515|APPLY LOWER LEG SPLINT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|29515||PC M/M HB CLINIC|126.00 PEMBINA COUNTY MEDICAL CENTER|29530|STRAPPING OF KNEE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|29530||PC STANDARD FEE SCHEDULE|95.00 PEMBINA COUNTY MEDICAL CENTER|29530|STRAPPING OF KNEE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|29530||PC M/M HB CLINIC|95.00 PEMBINA COUNTY MEDICAL CENTER|29550|STRAPPING OF TOES|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|29550||PC STANDARD FEE SCHEDULE|50.00 PEMBINA COUNTY MEDICAL CENTER|29550|STRAPPING OF TOES|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|29550||PC M/M HB CLINIC|50.00 PEMBINA COUNTY MEDICAL CENTER|30300|REMOVE NASAL FOREIGN BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|30300||PC STANDARD FEE SCHEDULE|325.00 PEMBINA COUNTY MEDICAL CENTER|30300|REMOVE NASAL FOREIGN BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|30300||PC M/M HB CLINIC|325.00 PEMBINA COUNTY MEDICAL CENTER|30901|CTRL NOSEBLEED,ANTER,SIMPLE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|30901||PC STANDARD FEE SCHEDULE|139.00 PEMBINA COUNTY MEDICAL CENTER|30901|CTRL NOSEBLEED,ANTER,SIMPLE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|30901||PC M/M HB CLINIC|139.00 PEMBINA COUNTY MEDICAL CENTER|30903|CTRL NOSEBLEED,ANTER,COMPLEX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|30903||PC STANDARD FEE SCHEDULE|197.00 PEMBINA COUNTY MEDICAL CENTER|30903|CTRL NOSEBLEED,ANTER,COMPLEX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|30903||PC M/M HB CLINIC|197.00 PEMBINA COUNTY MEDICAL CENTER|30905|CTRL NOSEBLEED,POST,W/PACKS &/OR CAUT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|30905||PC STANDARD FEE SCHEDULE|248.00 PEMBINA COUNTY MEDICAL CENTER|30905|CTRL NOSEBLEED,POST,W/PACKS &/OR CAUT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|30905||PC M/M HB CLINIC|248.00 PEMBINA COUNTY MEDICAL CENTER|30906|REPEAT CONTROL OF NOSEBLEED|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|30906||PC STANDARD FEE SCHEDULE|323.00 PEMBINA COUNTY MEDICAL CENTER|30906|REPEAT CONTROL OF NOSEBLEED|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|30906||PC M/M HB CLINIC|323.00 PEMBINA COUNTY MEDICAL CENTER|31500|INSERT EMERGENCY ENDOTRACH AIRWAY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|31500||PC STANDARD FEE SCHEDULE|270.00 PEMBINA COUNTY MEDICAL CENTER|31500|INSERT EMERGENCY ENDOTRACH AIRWAY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|31500||PC M/M HB CLINIC|270.00 PEMBINA COUNTY MEDICAL CENTER|31505|LARYNGOSCOPY,INDIRECT,DX|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|31505||PC STANDARD FEE SCHEDULE|126.00 PEMBINA COUNTY MEDICAL CENTER|31505|LARYNGOSCOPY,INDIRECT,DX|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|31505||PC M/M HB CLINIC|126.00 PEMBINA COUNTY MEDICAL CENTER|31622|BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|31622||PC STANDARD FEE SCHEDULE|366.00 PEMBINA COUNTY MEDICAL CENTER|31622|BRNCHSC INCL FLUOR GDNCE DX W/CELL WASHG SPX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|31622||PC M/M HB CLINIC|366.00 PEMBINA COUNTY MEDICAL CENTER|32405|BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE|PROFESSIONAL FEES - OPERATING ROOM [0975]|32405||PC STANDARD FEE SCHEDULE|255.00 PEMBINA COUNTY MEDICAL CENTER|32405|BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE|PROFESSIONAL FEES - OPERATING ROOM [0975]|32405||PC M/M HB CLINIC|255.00 PEMBINA COUNTY MEDICAL CENTER|32960|THERAPEUTIC PNEUMOTHORAX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|32960||PC STANDARD FEE SCHEDULE|258.00 PEMBINA COUNTY MEDICAL CENTER|32960|THERAPEUTIC PNEUMOTHORAX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|32960||PC M/M HB CLINIC|258.00 PEMBINA COUNTY MEDICAL CENTER|35206|REPR BL VES DIRECT,UP EXTREM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|35206||PC STANDARD FEE SCHEDULE|1,982.00 PEMBINA COUNTY MEDICAL CENTER|35206|REPR BL VES DIRECT,UP EXTREM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|35206||PC M/M HB CLINIC|1,982.00 PEMBINA COUNTY MEDICAL CENTER|36556|INSERT NON-TUNNEL CV CATH|PROFESSIONAL FEES - HOSPITAL VISIT [0987]|36556||PC STANDARD FEE SCHEDULE|299.00 PEMBINA COUNTY MEDICAL CENTER|36556|INSERT NON-TUNNEL CV CATH|PROFESSIONAL FEES - HOSPITAL VISIT [0987]|36556||PC M/M HB CLINIC|299.00 PEMBINA COUNTY MEDICAL CENTER|36558|INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>|PROFESSIONAL FEES - OPERATING ROOM [0975]|36558||PC STANDARD FEE SCHEDULE|698.00 PEMBINA COUNTY MEDICAL CENTER|36558|INSJ TUNNELED CVC W/O SUBQ PORT/PMP AGE 5 YR/>|PROFESSIONAL FEES - OPERATING ROOM [0975]|36558||PC M/M HB CLINIC|698.00 PEMBINA COUNTY MEDICAL CENTER|36561|INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>|PROFESSIONAL FEES - OPERATING ROOM [0975]|36561||PC STANDARD FEE SCHEDULE|892.00 PEMBINA COUNTY MEDICAL CENTER|36561|INSJ TUNNELED CTR VAD W/SUBQ PORT AGE 5 YR/>|PROFESSIONAL FEES - OPERATING ROOM [0975]|36561||PC M/M HB CLINIC|892.00 PEMBINA COUNTY MEDICAL CENTER|36569|INSERTION PICC W/O IMG GDN 5 YR/>|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|36569||PC STANDARD FEE SCHEDULE|226.00 PEMBINA COUNTY MEDICAL CENTER|36569|INSERTION PICC W/O IMG GDN 5 YR/>|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|36569||PC M/M HB CLINIC|226.00 PEMBINA COUNTY MEDICAL CENTER|36589|REMOVAL TUNNELED CV CATH|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|36589||PC STANDARD FEE SCHEDULE|352.00 PEMBINA COUNTY MEDICAL CENTER|36589|REMOVAL TUNNELED CV CATH|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|36589||PC M/M HB CLINIC|352.00 PEMBINA COUNTY MEDICAL CENTER|36620|INSERT CATH,ART,PERCUT,SHORTTERM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|36620||PC STANDARD FEE SCHEDULE|125.00 PEMBINA COUNTY MEDICAL CENTER|36620|INSERT CATH,ART,PERCUT,SHORTTERM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|36620||PC M/M HB CLINIC|125.00 PEMBINA COUNTY MEDICAL CENTER|38100|REMOVAL SPLEEN, TOTAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|38100||PC STANDARD FEE SCHEDULE|2,843.00 PEMBINA COUNTY MEDICAL CENTER|38100|REMOVAL SPLEEN, TOTAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|38100||PC M/M HB CLINIC|2,843.00 PEMBINA COUNTY MEDICAL CENTER|38500|BIOPSY/EXCISION, LYMPH NODE(S)|PROFESSIONAL FEES - OPERATING ROOM [0975]|38500||PC STANDARD FEE SCHEDULE|633.00 PEMBINA COUNTY MEDICAL CENTER|38500|BIOPSY/EXCISION, LYMPH NODE(S)|PROFESSIONAL FEES - OPERATING ROOM [0975]|38500||PC M/M HB CLINIC|633.00 PEMBINA COUNTY MEDICAL CENTER|38505|NEEDLE BIOPSY, LYMPH NODE(S)|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|38505||PC STANDARD FEE SCHEDULE|179.00 PEMBINA COUNTY MEDICAL CENTER|38505|NEEDLE BIOPSY, LYMPH NODE(S)|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|38505||PC M/M HB CLINIC|179.00 PEMBINA COUNTY MEDICAL CENTER|38510|BX/REMV,LYMPH NODE,DEEP CERV|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|38510||PC STANDARD FEE SCHEDULE|1,046.00 PEMBINA COUNTY MEDICAL CENTER|38510|BX/REMV,LYMPH NODE,DEEP CERV|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|38510||PC M/M HB CLINIC|1,046.00 PEMBINA COUNTY MEDICAL CENTER|38525|BX/REMV,LYMPH NODE,DEEP AXILL|PROFESSIONAL FEES - OPERATING ROOM [0975]|38525||PC STANDARD FEE SCHEDULE|1,085.00 PEMBINA COUNTY MEDICAL CENTER|38525|BX/REMV,LYMPH NODE,DEEP AXILL|PROFESSIONAL FEES - OPERATING ROOM [0975]|38525||PC M/M HB CLINIC|1,085.00 PEMBINA COUNTY MEDICAL CENTER|38542|EXPLORE DEEP NODE(S), NECK|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|38542||PC STANDARD FEE SCHEDULE|1,294.00 PEMBINA COUNTY MEDICAL CENTER|38542|EXPLORE DEEP NODE(S), NECK|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|38542||PC M/M HB CLINIC|1,294.00 PEMBINA COUNTY MEDICAL CENTER|40490|BIOPSY OF LIP|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|40490||PC STANDARD FEE SCHEDULE|311.00 PEMBINA COUNTY MEDICAL CENTER|40490|BIOPSY OF LIP|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|40490||PC M/M HB CLINIC|179.00 PEMBINA COUNTY MEDICAL CENTER|40510|PARTIAL EXCIS LIP,WEDGE PRIM CLOS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|40510||PC STANDARD FEE SCHEDULE|898.00 PEMBINA COUNTY MEDICAL CENTER|40510|PARTIAL EXCIS LIP,WEDGE PRIM CLOS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|40510||PC M/M HB CLINIC|898.00 PEMBINA COUNTY MEDICAL CENTER|41110|EXCIS TONGUE LESN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|41110||PC STANDARD FEE SCHEDULE|340.00 PEMBINA COUNTY MEDICAL CENTER|41110|EXCIS TONGUE LESN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|41110||PC M/M HB CLINIC|340.00 PEMBINA COUNTY MEDICAL CENTER|41250|REPAIR TONGUE LACER,<2.6CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|41250||PC STANDARD FEE SCHEDULE|401.00 PEMBINA COUNTY MEDICAL CENTER|41250|REPAIR TONGUE LACER,<2.6CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|41250||PC M/M HB CLINIC|401.00 PEMBINA COUNTY MEDICAL CENTER|41252|REPAIR TONGUE LACER,2.6CM+/COMPLX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|41252||PC STANDARD FEE SCHEDULE|536.00 PEMBINA COUNTY MEDICAL CENTER|41252|REPAIR TONGUE LACER,2.6CM+/COMPLX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|41252||PC M/M HB CLINIC|536.00 PEMBINA COUNTY MEDICAL CENTER|41805|REMOVAL FOREIGN BODY, GUM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|41805||PC STANDARD FEE SCHEDULE|444.00 PEMBINA COUNTY MEDICAL CENTER|41805|REMOVAL FOREIGN BODY, GUM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|41805||PC M/M HB CLINIC|444.00 PEMBINA COUNTY MEDICAL CENTER|42330|REMOVAL SALIVARY STONE,UNCOMPLIC|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|42330||PC STANDARD FEE SCHEDULE|420.00 PEMBINA COUNTY MEDICAL CENTER|42330|REMOVAL SALIVARY STONE,UNCOMPLIC|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|42330||PC M/M HB CLINIC|420.00 PEMBINA COUNTY MEDICAL CENTER|42405|BIOPSY SALIVARY GLAND,INCISIONAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|42405||PC STANDARD FEE SCHEDULE|570.00 PEMBINA COUNTY MEDICAL CENTER|42405|BIOPSY SALIVARY GLAND,INCISIONAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|42405||PC M/M HB CLINIC|570.00 PEMBINA COUNTY MEDICAL CENTER|42809|REMOVE PHARYNX FOREIGN BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|42809||PC STANDARD FEE SCHEDULE|339.00 PEMBINA COUNTY MEDICAL CENTER|42809|REMOVE PHARYNX FOREIGN BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|42809||PC M/M HB CLINIC|339.00 PEMBINA COUNTY MEDICAL CENTER|43130|REMOV ESOPHAG DIVERTIC,CERV APPRCH|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43130||PC STANDARD FEE SCHEDULE|1,972.00 PEMBINA COUNTY MEDICAL CENTER|43130|REMOV ESOPHAG DIVERTIC,CERV APPRCH|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43130||PC M/M HB CLINIC|1,972.00 PEMBINA COUNTY MEDICAL CENTER|43200|ESOPHAGOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43200||PC STANDARD FEE SCHEDULE|264.00 PEMBINA COUNTY MEDICAL CENTER|43200|ESOPHAGOSCOPY FLEXIBLE TRANSORAL DIAGNOSTIC|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43200||PC M/M HB CLINIC|264.00 PEMBINA COUNTY MEDICAL CENTER|43202|ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43202||PC STANDARD FEE SCHEDULE|290.00 PEMBINA COUNTY MEDICAL CENTER|43202|ESOPHAGOSCOPY FLEXIBLE TRANSORAL WITH BIOPSY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43202||PC M/M HB CLINIC|290.00 PEMBINA COUNTY MEDICAL CENTER|43235|ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC|PROFESSIONAL FEES - OPERATING ROOM [0975]|43235||PC STANDARD FEE SCHEDULE|365.00 PEMBINA COUNTY MEDICAL CENTER|43235|ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC|PROFESSIONAL FEES - OPERATING ROOM [0975]|43235||PC M/M HB CLINIC|365.00 PEMBINA COUNTY MEDICAL CENTER|43239|EGD TRANSORAL BIOPSY SINGLE/MULTIPLE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43239||PC STANDARD FEE SCHEDULE|431.00 PEMBINA COUNTY MEDICAL CENTER|43239|EGD TRANSORAL BIOPSY SINGLE/MULTIPLE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43239||PC M/M HB CLINIC|431.00 PEMBINA COUNTY MEDICAL CENTER|43245|EGD DILATION GASTRIC/DUODENAL STRICTURE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43245||PC STANDARD FEE SCHEDULE|469.00 PEMBINA COUNTY MEDICAL CENTER|43245|EGD DILATION GASTRIC/DUODENAL STRICTURE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43245||PC M/M HB CLINIC|469.00 PEMBINA COUNTY MEDICAL CENTER|43246|EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE|PROFESSIONAL FEES - OPERATING ROOM [0975]|43246||PC STANDARD FEE SCHEDULE|629.00 PEMBINA COUNTY MEDICAL CENTER|43246|EGD PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE|PROFESSIONAL FEES - OPERATING ROOM [0975]|43246||PC M/M HB CLINIC|629.00 PEMBINA COUNTY MEDICAL CENTER|43247|EGD FLEXIBLE FOREIGN BODY REMOVAL|PROFESSIONAL FEES - OPERATING ROOM [0975]|43247||PC STANDARD FEE SCHEDULE|501.00 PEMBINA COUNTY MEDICAL CENTER|43247|EGD FLEXIBLE FOREIGN BODY REMOVAL|PROFESSIONAL FEES - OPERATING ROOM [0975]|43247||PC M/M HB CLINIC|501.00 PEMBINA COUNTY MEDICAL CENTER|43249|EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43249||PC STANDARD FEE SCHEDULE|434.00 PEMBINA COUNTY MEDICAL CENTER|43249|EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43249||PC M/M HB CLINIC|434.00 PEMBINA COUNTY MEDICAL CENTER|43250|EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43250||PC STANDARD FEE SCHEDULE|473.00 PEMBINA COUNTY MEDICAL CENTER|43250|EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43250||PC M/M HB CLINIC|473.00 PEMBINA COUNTY MEDICAL CENTER|43251|EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH|PROFESSIONAL FEES - OPERATING ROOM [0975]|43251||PC STANDARD FEE SCHEDULE|545.00 PEMBINA COUNTY MEDICAL CENTER|43251|EGD REMOVAL TUMOR POLYP/OTHER LESION SNARE TECH|PROFESSIONAL FEES - OPERATING ROOM [0975]|43251||PC M/M HB CLINIC|545.00 PEMBINA COUNTY MEDICAL CENTER|43280|LAP,ESOPHAGOGAST FUNDOPLASTY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43280||PC STANDARD FEE SCHEDULE|2,674.00 PEMBINA COUNTY MEDICAL CENTER|43280|LAP,ESOPHAGOGAST FUNDOPLASTY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43280||PC M/M HB CLINIC|2,674.00 PEMBINA COUNTY MEDICAL CENTER|43450|DILATE ESOPHAGUS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43450||PC STANDARD FEE SCHEDULE|225.00 PEMBINA COUNTY MEDICAL CENTER|43450|DILATE ESOPHAGUS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43450||PC M/M HB CLINIC|225.00 PEMBINA COUNTY MEDICAL CENTER|43760|CHANGE GASTROSTOMY TUBE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43760||PC STANDARD FEE SCHEDULE|122.00 PEMBINA COUNTY MEDICAL CENTER|43760|CHANGE GASTROSTOMY TUBE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43760||PC M/M HB CLINIC|122.00 PEMBINA COUNTY MEDICAL CENTER|43800|RECONSTRUCTION OF PYLORUS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43800||PC STANDARD FEE SCHEDULE|2,298.00 PEMBINA COUNTY MEDICAL CENTER|43800|RECONSTRUCTION OF PYLORUS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43800||PC M/M HB CLINIC|2,298.00 PEMBINA COUNTY MEDICAL CENTER|43860|REVISE,GASTROJEJUN ANAST,W/O VAGOTOMY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43860||PC STANDARD FEE SCHEDULE|4,026.00 PEMBINA COUNTY MEDICAL CENTER|43860|REVISE,GASTROJEJUN ANAST,W/O VAGOTOMY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43860||PC M/M HB CLINIC|4,026.00 PEMBINA COUNTY MEDICAL CENTER|44005|FREEING BOWEL ADHESION,ENTEROLYSIS|PROFESSIONAL FEES - OPERATING ROOM [0975]|44005||PC STANDARD FEE SCHEDULE|2,700.00 PEMBINA COUNTY MEDICAL CENTER|44005|FREEING BOWEL ADHESION,ENTEROLYSIS|PROFESSIONAL FEES - OPERATING ROOM [0975]|44005||PC M/M HB CLINIC|2,700.00 PEMBINA COUNTY MEDICAL CENTER|44015|INSERT TUBE-BOWEL,ENTERAL ALIMENT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44015||PC STANDARD FEE SCHEDULE|351.00 PEMBINA COUNTY MEDICAL CENTER|44015|INSERT TUBE-BOWEL,ENTERAL ALIMENT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44015||PC M/M HB CLINIC|351.00 PEMBINA COUNTY MEDICAL CENTER|44021|ENTEROTOMY DECOMPRESS SMALL BOWEL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44021||PC STANDARD FEE SCHEDULE|2,413.00 PEMBINA COUNTY MEDICAL CENTER|44021|ENTEROTOMY DECOMPRESS SMALL BOWEL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44021||PC M/M HB CLINIC|2,413.00 PEMBINA COUNTY MEDICAL CENTER|44050|REDUCE VOLVULUS,INTUSS,INTERN HERNIA|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44050||PC STANDARD FEE SCHEDULE|2,313.00 PEMBINA COUNTY MEDICAL CENTER|44050|REDUCE VOLVULUS,INTUSS,INTERN HERNIA|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44050||PC M/M HB CLINIC|2,313.00 PEMBINA COUNTY MEDICAL CENTER|44055|CORRECT MALROTATION OF BOWEL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44055||PC STANDARD FEE SCHEDULE|3,691.00 PEMBINA COUNTY MEDICAL CENTER|44055|CORRECT MALROTATION OF BOWEL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44055||PC M/M HB CLINIC|3,691.00 PEMBINA COUNTY MEDICAL CENTER|44120|RESECT SMALL INTEST,SINGL RESEC/ANAS|PROFESSIONAL FEES - OPERATING ROOM [0975]|44120||PC STANDARD FEE SCHEDULE|3,018.00 PEMBINA COUNTY MEDICAL CENTER|44120|RESECT SMALL INTEST,SINGL RESEC/ANAS|PROFESSIONAL FEES - OPERATING ROOM [0975]|44120||PC M/M HB CLINIC|3,018.00 PEMBINA COUNTY MEDICAL CENTER|44125|RESECT SMALL INTEST W ENTEROSTOMY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44125||PC STANDARD FEE SCHEDULE|2,919.00 PEMBINA COUNTY MEDICAL CENTER|44125|RESECT SMALL INTEST W ENTEROSTOMY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44125||PC M/M HB CLINIC|2,919.00 PEMBINA COUNTY MEDICAL CENTER|44130|BOWEL TO BOWEL ANASTOMOSIS|PROFESSIONAL FEES - OPERATING ROOM [0975]|44130||PC STANDARD FEE SCHEDULE|3,247.00 PEMBINA COUNTY MEDICAL CENTER|44130|BOWEL TO BOWEL ANASTOMOSIS|PROFESSIONAL FEES - OPERATING ROOM [0975]|44130||PC M/M HB CLINIC|3,247.00 PEMBINA COUNTY MEDICAL CENTER|44139|MOBILIZE SPLENIC FLEX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44139||PC STANDARD FEE SCHEDULE|299.00 PEMBINA COUNTY MEDICAL CENTER|44139|MOBILIZE SPLENIC FLEX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44139||PC M/M HB CLINIC|299.00 PEMBINA COUNTY MEDICAL CENTER|44140|PART REMOVAL COLON W ANASTOMOSIS|PROFESSIONAL FEES - OPERATING ROOM [0975]|44140||PC STANDARD FEE SCHEDULE|3,314.00 PEMBINA COUNTY MEDICAL CENTER|44140|PART REMOVAL COLON W ANASTOMOSIS|PROFESSIONAL FEES - OPERATING ROOM [0975]|44140||PC M/M HB CLINIC|3,314.00 PEMBINA COUNTY MEDICAL CENTER|44141|PART REMOVAL COLON W COLOSTOMY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44141||PC STANDARD FEE SCHEDULE|4,524.00 PEMBINA COUNTY MEDICAL CENTER|44141|PART REMOVAL COLON W COLOSTOMY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44141||PC M/M HB CLINIC|4,524.00 PEMBINA COUNTY MEDICAL CENTER|44143|PART REMOVAL COLON W END COLOSTOMY|PROFESSIONAL FEES - OPERATING ROOM [0975]|44143||PC STANDARD FEE SCHEDULE|4,120.00 PEMBINA COUNTY MEDICAL CENTER|44143|PART REMOVAL COLON W END COLOSTOMY|PROFESSIONAL FEES - OPERATING ROOM [0975]|44143||PC M/M HB CLINIC|4,120.00 PEMBINA COUNTY MEDICAL CENTER|44144|PART REMOVAL COLON W OSTOMY/MUCOFIST|PROFESSIONAL FEES - OPERATING ROOM [0975]|44144||PC STANDARD FEE SCHEDULE|4,382.00 PEMBINA COUNTY MEDICAL CENTER|44144|PART REMOVAL COLON W OSTOMY/MUCOFIST|PROFESSIONAL FEES - OPERATING ROOM [0975]|44144||PC M/M HB CLINIC|4,382.00 PEMBINA COUNTY MEDICAL CENTER|44145|PART REMOVAL COLON W COLOPROCTOSTOMY|PROFESSIONAL FEES - OPERATING ROOM [0975]|44145||PC STANDARD FEE SCHEDULE|4,099.00 PEMBINA COUNTY MEDICAL CENTER|44145|PART REMOVAL COLON W COLOPROCTOSTOMY|PROFESSIONAL FEES - OPERATING ROOM [0975]|44145||PC M/M HB CLINIC|4,099.00 PEMBINA COUNTY MEDICAL CENTER|44160|REMVL COLON & TERM ILEUM W/ILEOCOLOSTOMY|PROFESSIONAL FEES - OPERATING ROOM [0975]|44160||PC STANDARD FEE SCHEDULE|3,070.00 PEMBINA COUNTY MEDICAL CENTER|44160|REMVL COLON & TERM ILEUM W/ILEOCOLOSTOMY|PROFESSIONAL FEES - OPERATING ROOM [0975]|44160||PC M/M HB CLINIC|3,070.00 PEMBINA COUNTY MEDICAL CENTER|44204|LAP,SURG,COLECTOMY, PARTIAL, W/ANAST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44204||PC STANDARD FEE SCHEDULE|3,811.00 PEMBINA COUNTY MEDICAL CENTER|44204|LAP,SURG,COLECTOMY, PARTIAL, W/ANAST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44204||PC M/M HB CLINIC|3,811.00 PEMBINA COUNTY MEDICAL CENTER|44207|LAP,SURG,COLECTOMY,W/ANAST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44207||PC STANDARD FEE SCHEDULE|4,521.00 PEMBINA COUNTY MEDICAL CENTER|44207|LAP,SURG,COLECTOMY,W/ANAST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44207||PC M/M HB CLINIC|4,521.00 PEMBINA COUNTY MEDICAL CENTER|44310|ILEOSTOMY/JEJUNOSTOMY,NONTUBE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44310||PC STANDARD FEE SCHEDULE|2,586.00 PEMBINA COUNTY MEDICAL CENTER|44310|ILEOSTOMY/JEJUNOSTOMY,NONTUBE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44310||PC M/M HB CLINIC|2,586.00 PEMBINA COUNTY MEDICAL CENTER|44320|COLOSTOMY|PROFESSIONAL FEES - RADIOLOGY - NUCLEAR [0974]|44320||PC STANDARD FEE SCHEDULE|2,979.00 PEMBINA COUNTY MEDICAL CENTER|44320|COLOSTOMY|PROFESSIONAL FEES - RADIOLOGY - NUCLEAR [0974]|44320||PC M/M HB CLINIC|2,979.00 PEMBINA COUNTY MEDICAL CENTER|44340|REVISION OF COLOSTOMY,SIMPLE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44340||PC STANDARD FEE SCHEDULE|1,562.00 PEMBINA COUNTY MEDICAL CENTER|44340|REVISION OF COLOSTOMY,SIMPLE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44340||PC M/M HB CLINIC|1,562.00 PEMBINA COUNTY MEDICAL CENTER|44388|COLONOSCOPY STOMA DX INCLUDING COLLJ SPEC SPX|PROFESSIONAL FEES - OPERATING ROOM [0975]|44388||PC STANDARD FEE SCHEDULE|416.00 PEMBINA COUNTY MEDICAL CENTER|44388|COLONOSCOPY STOMA DX INCLUDING COLLJ SPEC SPX|PROFESSIONAL FEES - OPERATING ROOM [0975]|44388||PC M/M HB CLINIC|416.00 PEMBINA COUNTY MEDICAL CENTER|44602|SUTURE SM INTEST,SINGLE PERF|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44602||PC STANDARD FEE SCHEDULE|3,474.00 PEMBINA COUNTY MEDICAL CENTER|44602|SUTURE SM INTEST,SINGLE PERF|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44602||PC M/M HB CLINIC|3,474.00 PEMBINA COUNTY MEDICAL CENTER|44604|SUTURE LRG INTEST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44604||PC STANDARD FEE SCHEDULE|2,608.00 PEMBINA COUNTY MEDICAL CENTER|44604|SUTURE LRG INTEST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44604||PC M/M HB CLINIC|2,608.00 PEMBINA COUNTY MEDICAL CENTER|44625|CLOSE ENTEROSTOMY,RESEC+ANAST|PROFESSIONAL FEES - OPERATING ROOM [0975]|44625||PC STANDARD FEE SCHEDULE|2,530.00 PEMBINA COUNTY MEDICAL CENTER|44625|CLOSE ENTEROSTOMY,RESEC+ANAST|PROFESSIONAL FEES - OPERATING ROOM [0975]|44625||PC M/M HB CLINIC|2,530.00 PEMBINA COUNTY MEDICAL CENTER|44626|CLOSE ENTEROSTOMY,RESEC+COLOREC ANAS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44626||PC STANDARD FEE SCHEDULE|3,962.00 PEMBINA COUNTY MEDICAL CENTER|44626|CLOSE ENTEROSTOMY,RESEC+COLOREC ANAS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44626||PC M/M HB CLINIC|3,962.00 PEMBINA COUNTY MEDICAL CENTER|44800|EXCISION MECKEL,OMPHALOMES DUCT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44800||PC STANDARD FEE SCHEDULE|1,896.00 PEMBINA COUNTY MEDICAL CENTER|44800|EXCISION MECKEL,OMPHALOMES DUCT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44800||PC M/M HB CLINIC|1,896.00 PEMBINA COUNTY MEDICAL CENTER|44820|EXCISION OF MESENTERY LESION|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44820||PC STANDARD FEE SCHEDULE|2,079.00 PEMBINA COUNTY MEDICAL CENTER|44820|EXCISION OF MESENTERY LESION|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|44820||PC M/M HB CLINIC|2,079.00 PEMBINA COUNTY MEDICAL CENTER|44950|APPENDECTOMY|PROFESSIONAL FEES - OPERATING ROOM [0975]|44950||PC STANDARD FEE SCHEDULE|1,587.00 PEMBINA COUNTY MEDICAL CENTER|44950|APPENDECTOMY|PROFESSIONAL FEES - OPERATING ROOM [0975]|44950||PC M/M HB CLINIC|1,587.00 PEMBINA COUNTY MEDICAL CENTER|44955|APPENDECTOMY,W OTHR PROC|PROFESSIONAL FEES - OPERATING ROOM [0975]|44955||PC STANDARD FEE SCHEDULE|206.00 PEMBINA COUNTY MEDICAL CENTER|44955|APPENDECTOMY,W OTHR PROC|PROFESSIONAL FEES - OPERATING ROOM [0975]|44955||PC M/M HB CLINIC|206.00 PEMBINA COUNTY MEDICAL CENTER|44960|APPENDECTOMY,RUPT APPENDX+ABSCESS|PROFESSIONAL FEES - OPERATING ROOM [0975]|44960||PC STANDARD FEE SCHEDULE|2,158.00 PEMBINA COUNTY MEDICAL CENTER|44960|APPENDECTOMY,RUPT APPENDX+ABSCESS|PROFESSIONAL FEES - OPERATING ROOM [0975]|44960||PC M/M HB CLINIC|2,158.00 PEMBINA COUNTY MEDICAL CENTER|44970|LAP,APPENDECTOMY|PROFESSIONAL FEES - OPERATING ROOM [0975]|44970||PC STANDARD FEE SCHEDULE|1,490.00 PEMBINA COUNTY MEDICAL CENTER|44970|LAP,APPENDECTOMY|PROFESSIONAL FEES - OPERATING ROOM [0975]|44970||PC M/M HB CLINIC|1,490.00 PEMBINA COUNTY MEDICAL CENTER|45300|PROCTOSIGMOIDOSCOPY,RIGID,DIAGNOS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|45300||PC STANDARD FEE SCHEDULE|137.00 PEMBINA COUNTY MEDICAL CENTER|45300|PROCTOSIGMOIDOSCOPY,RIGID,DIAGNOS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|45300||PC M/M HB CLINIC|137.00 PEMBINA COUNTY MEDICAL CENTER|45305|PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE|PROFESSIONAL FEES - OPERATING ROOM [0975]|45305||PC STANDARD FEE SCHEDULE|199.00 PEMBINA COUNTY MEDICAL CENTER|45305|PROCTOSGMDSC RIGID W/BX SINGLE/MULTIPLE|PROFESSIONAL FEES - OPERATING ROOM [0975]|45305||PC M/M HB CLINIC|199.00 PEMBINA COUNTY MEDICAL CENTER|45309|PROCTOSGMDSC RIGID RMVL 1 LESION SNARE TQ|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|45309||PC STANDARD FEE SCHEDULE|235.00 PEMBINA COUNTY MEDICAL CENTER|45309|PROCTOSGMDSC RIGID RMVL 1 LESION SNARE TQ|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|45309||PC M/M HB CLINIC|235.00 PEMBINA COUNTY MEDICAL CENTER|45330|SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD|PROFESSIONAL FEES - OPERATING ROOM [0975]|45330||PC STANDARD FEE SCHEDULE|161.00 PEMBINA COUNTY MEDICAL CENTER|45330|SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD|PROFESSIONAL FEES - OPERATING ROOM [0975]|45330||PC M/M HB CLINIC|161.00 PEMBINA COUNTY MEDICAL CENTER|45331|SIGMOIDOSCOPY,BIOPSY|PROFESSIONAL FEES - OPERATING ROOM [0975]|45331||PC STANDARD FEE SCHEDULE|194.00 PEMBINA COUNTY MEDICAL CENTER|45331|SIGMOIDOSCOPY,BIOPSY|PROFESSIONAL FEES - OPERATING ROOM [0975]|45331||PC M/M HB CLINIC|194.00 PEMBINA COUNTY MEDICAL CENTER|45338|SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ|PROFESSIONAL FEES - OPERATING ROOM [0975]|45338||PC STANDARD FEE SCHEDULE|354.00 PEMBINA COUNTY MEDICAL CENTER|45338|SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ|PROFESSIONAL FEES - OPERATING ROOM [0975]|45338||PC M/M HB CLINIC|354.00 PEMBINA COUNTY MEDICAL CENTER|45340|SIGMOIDOSCOPY FLX TNDSC BALO DILAT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|45340||PC M/M HB CLINIC|279.00 PEMBINA COUNTY MEDICAL CENTER|45378|COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD|PROFESSIONAL FEES - OPERATING ROOM [0975]|45378||PC STANDARD FEE SCHEDULE|542.00 PEMBINA COUNTY MEDICAL CENTER|45378|COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD|PROFESSIONAL FEES - OPERATING ROOM [0975]|45378||PC M/M HB CLINIC|542.00 PEMBINA COUNTY MEDICAL CENTER|45380|COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE|PROFESSIONAL FEES - OPERATING ROOM [0975]|45380||PC STANDARD FEE SCHEDULE|646.00 PEMBINA COUNTY MEDICAL CENTER|45380|COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE|PROFESSIONAL FEES - OPERATING ROOM [0975]|45380||PC M/M HB CLINIC|646.00 PEMBINA COUNTY MEDICAL CENTER|45381|COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|45381||PC STANDARD FEE SCHEDULE|615.00 PEMBINA COUNTY MEDICAL CENTER|45381|COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|45381||PC M/M HB CLINIC|615.00 PEMBINA COUNTY MEDICAL CENTER|45382|COLSC FLEXIBLE W/CONTROL BLEEDING ANY METHOD|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|45382||PC STANDARD FEE SCHEDULE|823.00 PEMBINA COUNTY MEDICAL CENTER|45382|COLSC FLEXIBLE W/CONTROL BLEEDING ANY METHOD|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|45382||PC M/M HB CLINIC|823.00 PEMBINA COUNTY MEDICAL CENTER|45384|COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS|PROFESSIONAL FEES - OPERATING ROOM [0975]|45384||PC STANDARD FEE SCHEDULE|676.00 PEMBINA COUNTY MEDICAL CENTER|45384|COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS|PROFESSIONAL FEES - OPERATING ROOM [0975]|45384||PC M/M HB CLINIC|676.00 PEMBINA COUNTY MEDICAL CENTER|45385|COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ|PROFESSIONAL FEES - OPERATING ROOM [0975]|45385||PC STANDARD FEE SCHEDULE|768.00 PEMBINA COUNTY MEDICAL CENTER|45385|COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ|PROFESSIONAL FEES - OPERATING ROOM [0975]|45385||PC M/M HB CLINIC|768.00 PEMBINA COUNTY MEDICAL CENTER|45386|COLSC FLEXIBLE W/TRANSENDOSCOPIC BALLOON DILAT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|45386||PC STANDARD FEE SCHEDULE|1,756.00 PEMBINA COUNTY MEDICAL CENTER|45386|COLSC FLEXIBLE W/TRANSENDOSCOPIC BALLOON DILAT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|45386||PC M/M HB CLINIC|1,756.00 PEMBINA COUNTY MEDICAL CENTER|46040|I&D PERIRECTAL ABSCESS|PROFESSIONAL FEES - OPERATING ROOM [0975]|46040||PC STANDARD FEE SCHEDULE|1,039.00 PEMBINA COUNTY MEDICAL CENTER|46040|I&D PERIRECTAL ABSCESS|PROFESSIONAL FEES - OPERATING ROOM [0975]|46040||PC M/M HB CLINIC|1,039.00 PEMBINA COUNTY MEDICAL CENTER|46045|I&D RECTAL WALL ABSCESS W ANESTH|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|46045||PC STANDARD FEE SCHEDULE|1,088.00 PEMBINA COUNTY MEDICAL CENTER|46045|I&D RECTAL WALL ABSCESS W ANESTH|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|46045||PC M/M HB CLINIC|1,088.00 PEMBINA COUNTY MEDICAL CENTER|46050|I&D PERIANAL ABSCESS,SUPERFICIAL|PROFESSIONAL FEES - OPERATING ROOM [0975]|46050||PC STANDARD FEE SCHEDULE|249.00 PEMBINA COUNTY MEDICAL CENTER|46050|I&D PERIANAL ABSCESS,SUPERFICIAL|PROFESSIONAL FEES - OPERATING ROOM [0975]|46050||PC M/M HB CLINIC|249.00 PEMBINA COUNTY MEDICAL CENTER|46080|ANAL SPHINCTEROTOMY|PROFESSIONAL FEES - OPERATING ROOM [0975]|46080||PC STANDARD FEE SCHEDULE|398.00 PEMBINA COUNTY MEDICAL CENTER|46080|ANAL SPHINCTEROTOMY|PROFESSIONAL FEES - OPERATING ROOM [0975]|46080||PC M/M HB CLINIC|398.00 PEMBINA COUNTY MEDICAL CENTER|46083|INCISE EXTERNAL HEMORRHOID|PROFESSIONAL FEES - OPERATING ROOM [0975]|46083||PC STANDARD FEE SCHEDULE|269.00 PEMBINA COUNTY MEDICAL CENTER|46083|INCISE EXTERNAL HEMORRHOID|PROFESSIONAL FEES - OPERATING ROOM [0975]|46083||PC M/M HB CLINIC|269.00 PEMBINA COUNTY MEDICAL CENTER|46200|REMOVAL OF ANAL FISSURE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|46200||PC STANDARD FEE SCHEDULE|824.00 PEMBINA COUNTY MEDICAL CENTER|46200|REMOVAL OF ANAL FISSURE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|46200||PC M/M HB CLINIC|824.00 PEMBINA COUNTY MEDICAL CENTER|46220|REMOVAL OF ANAL TAB|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|46220||PC STANDARD FEE SCHEDULE|300.00 PEMBINA COUNTY MEDICAL CENTER|46220|REMOVAL OF ANAL TAB|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|46220||PC M/M HB CLINIC|300.00 PEMBINA COUNTY MEDICAL CENTER|46230|REMOVAL OF ANAL TAGS|PROFESSIONAL FEES - OPERATING ROOM [0975]|46230||PC STANDARD FEE SCHEDULE|434.00 PEMBINA COUNTY MEDICAL CENTER|46230|REMOVAL OF ANAL TAGS|PROFESSIONAL FEES - OPERATING ROOM [0975]|46230||PC M/M HB CLINIC|434.00 PEMBINA COUNTY MEDICAL CENTER|46250|HEMORRHOIDECTOMY,EXTERNAL|PROFESSIONAL FEES - OPERATING ROOM [0975]|46250||PC STANDARD FEE SCHEDULE|790.00 PEMBINA COUNTY MEDICAL CENTER|46250|HEMORRHOIDECTOMY,EXTERNAL|PROFESSIONAL FEES - OPERATING ROOM [0975]|46250||PC M/M HB CLINIC|790.00 PEMBINA COUNTY MEDICAL CENTER|46255|HEMORRHOIDECTOMY,INT/EXT,SIMPLE|PROFESSIONAL FEES - OPERATING ROOM [0975]|46255||PC STANDARD FEE SCHEDULE|886.00 PEMBINA COUNTY MEDICAL CENTER|46255|HEMORRHOIDECTOMY,INT/EXT,SIMPLE|PROFESSIONAL FEES - OPERATING ROOM [0975]|46255||PC M/M HB CLINIC|886.00 PEMBINA COUNTY MEDICAL CENTER|46260|HEMORRHOIDECTOMY,INT/EXT,COMPLX|PROFESSIONAL FEES - OPERATING ROOM [0975]|46260||PC STANDARD FEE SCHEDULE|1,189.00 PEMBINA COUNTY MEDICAL CENTER|46260|HEMORRHOIDECTOMY,INT/EXT,COMPLX|PROFESSIONAL FEES - OPERATING ROOM [0975]|46260||PC M/M HB CLINIC|1,189.00 PEMBINA COUNTY MEDICAL CENTER|46275|REMOVAL ANAL FISTULA,SUBMUSCULAR|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|46275||PC STANDARD FEE SCHEDULE|1,042.00 PEMBINA COUNTY MEDICAL CENTER|46275|REMOVAL ANAL FISTULA,SUBMUSCULAR|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|46275||PC M/M HB CLINIC|1,042.00 PEMBINA COUNTY MEDICAL CENTER|46280|REMOVAL ANAL FISTULA,COMPLEX/MULTI|PROFESSIONAL FEES - OPERATING ROOM [0975]|46280||PC STANDARD FEE SCHEDULE|1,182.00 PEMBINA COUNTY MEDICAL CENTER|46280|REMOVAL ANAL FISTULA,COMPLEX/MULTI|PROFESSIONAL FEES - OPERATING ROOM [0975]|46280||PC M/M HB CLINIC|1,182.00 PEMBINA COUNTY MEDICAL CENTER|46320|REMOVAL OF HEMORRHOID CLOT|PROFESSIONAL FEES - OPERATING ROOM [0975]|46320||PC STANDARD FEE SCHEDULE|279.00 PEMBINA COUNTY MEDICAL CENTER|46320|REMOVAL OF HEMORRHOID CLOT|PROFESSIONAL FEES - OPERATING ROOM [0975]|46320||PC M/M HB CLINIC|279.00 PEMBINA COUNTY MEDICAL CENTER|46600|ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD|PROFESSIONAL FEES - OPERATING ROOM [0975]|46600||PC STANDARD FEE SCHEDULE|104.00 PEMBINA COUNTY MEDICAL CENTER|46600|ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD|PROFESSIONAL FEES - OPERATING ROOM [0975]|46600||PC M/M HB CLINIC|104.00 PEMBINA COUNTY MEDICAL CENTER|46612|ANOSCOPY,REMOVE LESIONS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|46612||PC STANDARD FEE SCHEDULE|237.00 PEMBINA COUNTY MEDICAL CENTER|46612|ANOSCOPY,REMOVE LESIONS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|46612||PC M/M HB CLINIC|237.00 PEMBINA COUNTY MEDICAL CENTER|46910|ELECTRODESSICATN,ANAL LESN(S)|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|46910||PC STANDARD FEE SCHEDULE|340.00 PEMBINA COUNTY MEDICAL CENTER|46910|ELECTRODESSICATN,ANAL LESN(S)|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|46910||PC M/M HB CLINIC|340.00 PEMBINA COUNTY MEDICAL CENTER|46945|LIGATE INTERN HEMORRHOIDS,SINGL PROC|PROFESSIONAL FEES - OPERATING ROOM [0975]|46945||PC STANDARD FEE SCHEDULE|577.00 PEMBINA COUNTY MEDICAL CENTER|46945|LIGATE INTERN HEMORRHOIDS,SINGL PROC|PROFESSIONAL FEES - OPERATING ROOM [0975]|46945||PC M/M HB CLINIC|577.00 PEMBINA COUNTY MEDICAL CENTER|46946|PR LIGATE INTERN HEMORRHOIDS,MULTI PROC|PROFESSIONAL FEES - OPERATING ROOM [0975]|46946||PC STANDARD FEE SCHEDULE|571.00 PEMBINA COUNTY MEDICAL CENTER|46946|PR LIGATE INTERN HEMORRHOIDS,MULTI PROC|PROFESSIONAL FEES - OPERATING ROOM [0975]|46946||PC M/M HB CLINIC|571.00 PEMBINA COUNTY MEDICAL CENTER|47001|NEEDLE BIOPSY LIVER,W OTHR PROC|PROFESSIONAL FEES - OPERATING ROOM [0975]|47001||PC STANDARD FEE SCHEDULE|252.00 PEMBINA COUNTY MEDICAL CENTER|47001|NEEDLE BIOPSY LIVER,W OTHR PROC|PROFESSIONAL FEES - OPERATING ROOM [0975]|47001||PC M/M HB CLINIC|252.00 PEMBINA COUNTY MEDICAL CENTER|47100|WEDGE BIOPSY OF LIVER|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|47100||PC STANDARD FEE SCHEDULE|2,098.00 PEMBINA COUNTY MEDICAL CENTER|47100|WEDGE BIOPSY OF LIVER|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|47100||PC M/M HB CLINIC|2,098.00 PEMBINA COUNTY MEDICAL CENTER|47562|LAP,CHOLECYSTECTOMY|PROFESSIONAL FEES - OPERATING ROOM [0975]|47562||PC STANDARD FEE SCHEDULE|1,630.00 PEMBINA COUNTY MEDICAL CENTER|47562|LAP,CHOLECYSTECTOMY|PROFESSIONAL FEES - OPERATING ROOM [0975]|47562||PC M/M HB CLINIC|1,630.00 PEMBINA COUNTY MEDICAL CENTER|47563|LAP,CHOLECYSTECTOMY/GRAPH|PROFESSIONAL FEES - OPERATING ROOM [0975]|47563||PC STANDARD FEE SCHEDULE|1,769.00 PEMBINA COUNTY MEDICAL CENTER|47563|LAP,CHOLECYSTECTOMY/GRAPH|PROFESSIONAL FEES - OPERATING ROOM [0975]|47563||PC M/M HB CLINIC|1,769.00 PEMBINA COUNTY MEDICAL CENTER|47600|REMOVAL GALLBLADDER|PROFESSIONAL FEES - OPERATING ROOM [0975]|47600||PC STANDARD FEE SCHEDULE|2,642.00 PEMBINA COUNTY MEDICAL CENTER|47600|REMOVAL GALLBLADDER|PROFESSIONAL FEES - OPERATING ROOM [0975]|47600||PC M/M HB CLINIC|2,642.00 PEMBINA COUNTY MEDICAL CENTER|49000|EXPLORATORY OF ABDOMEN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|49000||PC STANDARD FEE SCHEDULE|1,906.00 PEMBINA COUNTY MEDICAL CENTER|49000|EXPLORATORY OF ABDOMEN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|49000||PC M/M HB CLINIC|1,906.00 PEMBINA COUNTY MEDICAL CENTER|49002|REOPEN RECENT ABD EXPLORATORY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|49002||PC STANDARD FEE SCHEDULE|2,581.00 PEMBINA COUNTY MEDICAL CENTER|49002|REOPEN RECENT ABD EXPLORATORY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|49002||PC M/M HB CLINIC|2,581.00 PEMBINA COUNTY MEDICAL CENTER|49010|EXPLORATORY RETROPERITONEAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|49010||PC STANDARD FEE SCHEDULE|2,312.00 PEMBINA COUNTY MEDICAL CENTER|49010|EXPLORATORY RETROPERITONEAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|49010||PC M/M HB CLINIC|2,312.00 PEMBINA COUNTY MEDICAL CENTER|49020|DRAIN ABD ABSCESS OPEN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|49020||PC STANDARD FEE SCHEDULE|3,925.00 PEMBINA COUNTY MEDICAL CENTER|49020|DRAIN ABD ABSCESS OPEN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|49020||PC M/M HB CLINIC|3,925.00 PEMBINA COUNTY MEDICAL CENTER|49060|DRAIN RETROPERITONEAL ABSCESS,OPEN|PROFESSIONAL FEES - OPERATING ROOM [0975]|49060||PC STANDARD FEE SCHEDULE|2,714.00 PEMBINA COUNTY MEDICAL CENTER|49060|DRAIN RETROPERITONEAL ABSCESS,OPEN|PROFESSIONAL FEES - OPERATING ROOM [0975]|49060||PC M/M HB CLINIC|2,714.00 PEMBINA COUNTY MEDICAL CENTER|49320|LAP,DIAGNOSTIC ABDOMEN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|49320||PC STANDARD FEE SCHEDULE|814.00 PEMBINA COUNTY MEDICAL CENTER|49320|LAP,DIAGNOSTIC ABDOMEN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|49320||PC M/M HB CLINIC|814.00 PEMBINA COUNTY MEDICAL CENTER|49321|LAP,DX SURGICAL ABD W/BIOPSY|PROFESSIONAL FEES - OPERATING ROOM [0975]|49321||PC STANDARD FEE SCHEDULE|861.00 PEMBINA COUNTY MEDICAL CENTER|49321|LAP,DX SURGICAL ABD W/BIOPSY|PROFESSIONAL FEES - OPERATING ROOM [0975]|49321||PC M/M HB CLINIC|861.00 PEMBINA COUNTY MEDICAL CENTER|49322|LAP,ABDOMEN,ASPIRATE CYST|PROFESSIONAL FEES - OPERATING ROOM [0975]|49322||PC STANDARD FEE SCHEDULE|921.00 PEMBINA COUNTY MEDICAL CENTER|49322|LAP,ABDOMEN,ASPIRATE CYST|PROFESSIONAL FEES - OPERATING ROOM [0975]|49322||PC M/M HB CLINIC|921.00 PEMBINA COUNTY MEDICAL CENTER|49422|REMOVAL TUNNELED INTRAPERITONEAL CATHETER|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|49422||PC STANDARD FEE SCHEDULE|947.00 PEMBINA COUNTY MEDICAL CENTER|49422|REMOVAL TUNNELED INTRAPERITONEAL CATHETER|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|49422||PC M/M HB CLINIC|947.00 PEMBINA COUNTY MEDICAL CENTER|49505|REPAIR ING HERNIA,5+Y/O,REDUCIBL|PROFESSIONAL FEES - OPERATING ROOM [0975]|49505||PC STANDARD FEE SCHEDULE|1,292.00 PEMBINA COUNTY MEDICAL CENTER|49505|REPAIR ING HERNIA,5+Y/O,REDUCIBL|PROFESSIONAL FEES - OPERATING ROOM [0975]|49505||PC M/M HB CLINIC|1,292.00 PEMBINA COUNTY MEDICAL CENTER|49507|REPAIR ING HERNIA,5+Y/O,STRANG|PROFESSIONAL FEES - OPERATING ROOM [0975]|49507||PC STANDARD FEE SCHEDULE|1,453.00 PEMBINA COUNTY MEDICAL CENTER|49507|REPAIR ING HERNIA,5+Y/O,STRANG|PROFESSIONAL FEES - OPERATING ROOM [0975]|49507||PC M/M HB CLINIC|1,453.00 PEMBINA COUNTY MEDICAL CENTER|49520|REPAIR RECURR INGUIN HERN,REDUCIBL|PROFESSIONAL FEES - OPERATING ROOM [0975]|49520||PC STANDARD FEE SCHEDULE|1,564.00 PEMBINA COUNTY MEDICAL CENTER|49520|REPAIR RECURR INGUIN HERN,REDUCIBL|PROFESSIONAL FEES - OPERATING ROOM [0975]|49520||PC M/M HB CLINIC|1,564.00 PEMBINA COUNTY MEDICAL CENTER|49525|REPAIR SLIDING INGUINAL HERNIA|PROFESSIONAL FEES - OPERATING ROOM [0975]|49525||PC STANDARD FEE SCHEDULE|1,419.00 PEMBINA COUNTY MEDICAL CENTER|49525|REPAIR SLIDING INGUINAL HERNIA|PROFESSIONAL FEES - OPERATING ROOM [0975]|49525||PC M/M HB CLINIC|1,419.00 PEMBINA COUNTY MEDICAL CENTER|49540|REPAIR LUMBAR HERNIA|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|49540||PC STANDARD FEE SCHEDULE|1,674.00 PEMBINA COUNTY MEDICAL CENTER|49540|REPAIR LUMBAR HERNIA|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|49540||PC M/M HB CLINIC|1,674.00 PEMBINA COUNTY MEDICAL CENTER|49553|REPAIR FEMORAL HERNIA,STRANG|PROFESSIONAL FEES - OPERATING ROOM [0975]|49553||PC STANDARD FEE SCHEDULE|1,564.00 PEMBINA COUNTY MEDICAL CENTER|49553|REPAIR FEMORAL HERNIA,STRANG|PROFESSIONAL FEES - OPERATING ROOM [0975]|49553||PC M/M HB CLINIC|1,564.00 PEMBINA COUNTY MEDICAL CENTER|49560|REPAIR INCISIONAL HERNIA,REDUCIBLE|PROFESSIONAL FEES - OPERATING ROOM [0975]|49560||PC STANDARD FEE SCHEDULE|1,823.00 PEMBINA COUNTY MEDICAL CENTER|49560|REPAIR INCISIONAL HERNIA,REDUCIBLE|PROFESSIONAL FEES - OPERATING ROOM [0975]|49560||PC M/M HB CLINIC|1,823.00 PEMBINA COUNTY MEDICAL CENTER|49561|REPAIR INCISIONAL HERNIA,STRANG|PROFESSIONAL FEES - OPERATING ROOM [0975]|49561||PC STANDARD FEE SCHEDULE|2,296.00 PEMBINA COUNTY MEDICAL CENTER|49561|REPAIR INCISIONAL HERNIA,STRANG|PROFESSIONAL FEES - OPERATING ROOM [0975]|49561||PC M/M HB CLINIC|2,296.00 PEMBINA COUNTY MEDICAL CENTER|49565|REPAIR RECURR INCIS HERNIA,REDUC|PROFESSIONAL FEES - OPERATING ROOM [0975]|49565||PC STANDARD FEE SCHEDULE|1,898.00 PEMBINA COUNTY MEDICAL CENTER|49565|REPAIR RECURR INCIS HERNIA,REDUC|PROFESSIONAL FEES - OPERATING ROOM [0975]|49565||PC M/M HB CLINIC|1,898.00 PEMBINA COUNTY MEDICAL CENTER|49566|REPAIR RECURR INCIS HERNIA,STRANG|PROFESSIONAL FEES - OPERATING ROOM [0975]|49566||PC STANDARD FEE SCHEDULE|2,320.00 PEMBINA COUNTY MEDICAL CENTER|49566|REPAIR RECURR INCIS HERNIA,STRANG|PROFESSIONAL FEES - OPERATING ROOM [0975]|49566||PC M/M HB CLINIC|2,320.00 PEMBINA COUNTY MEDICAL CENTER|49568|REPAIR INCIS HERNIA W MESH|PROFESSIONAL FEES - OPERATING ROOM [0975]|49568||PC STANDARD FEE SCHEDULE|658.00 PEMBINA COUNTY MEDICAL CENTER|49568|REPAIR INCIS HERNIA W MESH|PROFESSIONAL FEES - OPERATING ROOM [0975]|49568||PC M/M HB CLINIC|658.00 PEMBINA COUNTY MEDICAL CENTER|49570|REPAIR EPIGASTRIC HERNIA,REDUC|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|49570||PC STANDARD FEE SCHEDULE|1,039.00 PEMBINA COUNTY MEDICAL CENTER|49570|REPAIR EPIGASTRIC HERNIA,REDUC|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|49570||PC M/M HB CLINIC|1,039.00 PEMBINA COUNTY MEDICAL CENTER|49585|REPAIR UMBILICAL HERN,5+Y/O,REDUC|PROFESSIONAL FEES - OPERATING ROOM [0975]|49585||PC STANDARD FEE SCHEDULE|1,104.00 PEMBINA COUNTY MEDICAL CENTER|49585|REPAIR UMBILICAL HERN,5+Y/O,REDUC|PROFESSIONAL FEES - OPERATING ROOM [0975]|49585||PC M/M HB CLINIC|1,104.00 PEMBINA COUNTY MEDICAL CENTER|49587|REPAIR UMBILICAL HERN,5+Y/O,STRANG|PROFESSIONAL FEES - OPERATING ROOM [0975]|49587||PC STANDARD FEE SCHEDULE|1,185.00 PEMBINA COUNTY MEDICAL CENTER|49587|REPAIR UMBILICAL HERN,5+Y/O,STRANG|PROFESSIONAL FEES - OPERATING ROOM [0975]|49587||PC M/M HB CLINIC|1,185.00 PEMBINA COUNTY MEDICAL CENTER|49650|LAP,INGUINAL HERNIA REPR,INITIAL|PROFESSIONAL FEES - OPERATING ROOM [0975]|49650||PC STANDARD FEE SCHEDULE|1,064.00 PEMBINA COUNTY MEDICAL CENTER|49650|LAP,INGUINAL HERNIA REPR,INITIAL|PROFESSIONAL FEES - OPERATING ROOM [0975]|49650||PC M/M HB CLINIC|1,064.00 PEMBINA COUNTY MEDICAL CENTER|49651|LAP,INGUINAL HERNIA REPR,RECUR|PROFESSIONAL FEES - OPERATING ROOM [0975]|49651||PC STANDARD FEE SCHEDULE|1,385.00 PEMBINA COUNTY MEDICAL CENTER|49651|LAP,INGUINAL HERNIA REPR,RECUR|PROFESSIONAL FEES - OPERATING ROOM [0975]|49651||PC M/M HB CLINIC|1,385.00 PEMBINA COUNTY MEDICAL CENTER|49659|LAP,HERNIA REPAIR PROC,UNLIST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|49659||PC STANDARD FEE SCHEDULE|906.00 PEMBINA COUNTY MEDICAL CENTER|49659|LAP,HERNIA REPAIR PROC,UNLIST|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|49659||PC M/M HB CLINIC|854.00 PEMBINA COUNTY MEDICAL CENTER|51020|INCISE/FULGUR LESN BLADDER|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|51020||PC STANDARD FEE SCHEDULE|1,146.00 PEMBINA COUNTY MEDICAL CENTER|51020|INCISE/FULGUR LESN BLADDER|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|51020||PC M/M HB CLINIC|1,146.00 PEMBINA COUNTY MEDICAL CENTER|51040|INCISE/DRAIN BLADDER|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|51040||PC STANDARD FEE SCHEDULE|709.00 PEMBINA COUNTY MEDICAL CENTER|51040|INCISE/DRAIN BLADDER|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|51040||PC M/M HB CLINIC|709.00 PEMBINA COUNTY MEDICAL CENTER|51700|IRRIGATION OF BLADDER|PROFESSIONAL FEES - OPERATING ROOM [0975]|51700||PC STANDARD FEE SCHEDULE|108.00 PEMBINA COUNTY MEDICAL CENTER|51700|IRRIGATION OF BLADDER|PROFESSIONAL FEES - OPERATING ROOM [0975]|51700||PC M/M HB CLINIC|108.00 PEMBINA COUNTY MEDICAL CENTER|51702|INSERT,TEMP INDWELLING BLAD CATH,SIMPLE|PROFESSIONAL FEES - OPERATING ROOM [0975]|51702||PC STANDARD FEE SCHEDULE|74.00 PEMBINA COUNTY MEDICAL CENTER|51702|INSERT,TEMP INDWELLING BLAD CATH,SIMPLE|PROFESSIONAL FEES - OPERATING ROOM [0975]|51702||PC M/M HB CLINIC|74.00 PEMBINA COUNTY MEDICAL CENTER|51705|CHANGE OF BLADDER TUBE,SIMPLE|PROFESSIONAL FEES - OPERATING ROOM [0975]|51705||PC STANDARD FEE SCHEDULE|129.00 PEMBINA COUNTY MEDICAL CENTER|51705|CHANGE OF BLADDER TUBE,SIMPLE|PROFESSIONAL FEES - OPERATING ROOM [0975]|51705||PC M/M HB CLINIC|129.00 PEMBINA COUNTY MEDICAL CENTER|51710|CHANGE OF BLADDER TUBE,COMPLICATED|PROFESSIONAL FEES - OPERATING ROOM [0975]|51710||PC STANDARD FEE SCHEDULE|196.00 PEMBINA COUNTY MEDICAL CENTER|51710|CHANGE OF BLADDER TUBE,COMPLICATED|PROFESSIONAL FEES - OPERATING ROOM [0975]|51710||PC M/M HB CLINIC|196.00 PEMBINA COUNTY MEDICAL CENTER|51720|INSTILL ANTICANCER AGENT IN BLADDER|PROFESSIONAL FEES - OPERATING ROOM [0975]|51720||PC STANDARD FEE SCHEDULE|195.00 PEMBINA COUNTY MEDICAL CENTER|51720|INSTILL ANTICANCER AGENT IN BLADDER|PROFESSIONAL FEES - OPERATING ROOM [0975]|51720||PC M/M HB CLINIC|195.00 PEMBINA COUNTY MEDICAL CENTER|51925|CLOSE BLAD/UTERINE FIST+HYSTERECT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|51925||PC STANDARD FEE SCHEDULE|2,588.00 PEMBINA COUNTY MEDICAL CENTER|51925|CLOSE BLAD/UTERINE FIST+HYSTERECT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|51925||PC M/M HB CLINIC|2,588.00 PEMBINA COUNTY MEDICAL CENTER|52000|CYSTOURETHROSCOPY|PROFESSIONAL FEES - OPERATING ROOM [0975]|52000||PC STANDARD FEE SCHEDULE|309.00 PEMBINA COUNTY MEDICAL CENTER|52000|CYSTOURETHROSCOPY|PROFESSIONAL FEES - OPERATING ROOM [0975]|52000||PC M/M HB CLINIC|309.00 PEMBINA COUNTY MEDICAL CENTER|52204|CYSTOURETHROSCOPY,BIOPSY|PROFESSIONAL FEES - OPERATING ROOM [0975]|52204||PC STANDARD FEE SCHEDULE|346.00 PEMBINA COUNTY MEDICAL CENTER|52204|CYSTOURETHROSCOPY,BIOPSY|PROFESSIONAL FEES - OPERATING ROOM [0975]|52204||PC M/M HB CLINIC|346.00 PEMBINA COUNTY MEDICAL CENTER|54150|CIRCUMCISION W/REGIONAL BLOCK|PROFESSIONAL FEES - OPERATING ROOM [0975]|54150||PC STANDARD FEE SCHEDULE|241.00 PEMBINA COUNTY MEDICAL CENTER|54150|CIRCUMCISION W/REGIONAL BLOCK|PROFESSIONAL FEES - OPERATING ROOM [0975]|54150||PC M/M HB CLINIC|241.00 PEMBINA COUNTY MEDICAL CENTER|54161|CIRCUMCISION,OTHR|PROFESSIONAL FEES - OPERATING ROOM [0975]|54161||PC STANDARD FEE SCHEDULE|481.00 PEMBINA COUNTY MEDICAL CENTER|54161|CIRCUMCISION,OTHR|PROFESSIONAL FEES - OPERATING ROOM [0975]|54161||PC M/M HB CLINIC|481.00 PEMBINA COUNTY MEDICAL CENTER|54530|REMOVAL TESTIS,RADICAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|54530||PC STANDARD FEE SCHEDULE|1,236.00 PEMBINA COUNTY MEDICAL CENTER|54530|REMOVAL TESTIS,RADICAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|54530||PC M/M HB CLINIC|1,236.00 PEMBINA COUNTY MEDICAL CENTER|54700|INCIS/DRAIN SCROTUM/TESTIS,EPIDIDYM|PROFESSIONAL FEES - OPERATING ROOM [0975]|54700||PC STANDARD FEE SCHEDULE|525.00 PEMBINA COUNTY MEDICAL CENTER|54700|INCIS/DRAIN SCROTUM/TESTIS,EPIDIDYM|PROFESSIONAL FEES - OPERATING ROOM [0975]|54700||PC M/M HB CLINIC|525.00 PEMBINA COUNTY MEDICAL CENTER|54840|EXCIS SPERMATOCELE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|54840||PC STANDARD FEE SCHEDULE|786.00 PEMBINA COUNTY MEDICAL CENTER|54840|EXCIS SPERMATOCELE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|54840||PC M/M HB CLINIC|786.00 PEMBINA COUNTY MEDICAL CENTER|55250|REMOVAL OF SPERM DUCT(S)|PROFESSIONAL FEES - OPERATING ROOM [0975]|55250||PC STANDARD FEE SCHEDULE|559.00 PEMBINA COUNTY MEDICAL CENTER|55250|REMOVAL OF SPERM DUCT(S)|PROFESSIONAL FEES - OPERATING ROOM [0975]|55250||PC M/M HB CLINIC|559.00 PEMBINA COUNTY MEDICAL CENTER|55500|REMV HYDROCELE,SPERM CORD,UNILAT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|55500||PC STANDARD FEE SCHEDULE|982.00 PEMBINA COUNTY MEDICAL CENTER|55500|REMV HYDROCELE,SPERM CORD,UNILAT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|55500||PC M/M HB CLINIC|982.00 PEMBINA COUNTY MEDICAL CENTER|56405|I&D OF VULVA/PERINEUM ABSCESS|PROFESSIONAL FEES - OPERATING ROOM [0975]|56405||PC STANDARD FEE SCHEDULE|275.00 PEMBINA COUNTY MEDICAL CENTER|56405|I&D OF VULVA/PERINEUM ABSCESS|PROFESSIONAL FEES - OPERATING ROOM [0975]|56405||PC M/M HB CLINIC|275.00 PEMBINA COUNTY MEDICAL CENTER|57520|CONIZATION CERVIX,KNIFE/LASER|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|57520||PC STANDARD FEE SCHEDULE|767.00 PEMBINA COUNTY MEDICAL CENTER|57520|CONIZATION CERVIX,KNIFE/LASER|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|57520||PC M/M HB CLINIC|767.00 PEMBINA COUNTY MEDICAL CENTER|58150|TOTAL ABDOM HYSTERECTOMY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|58150||PC STANDARD FEE SCHEDULE|2,497.00 PEMBINA COUNTY MEDICAL CENTER|58150|TOTAL ABDOM HYSTERECTOMY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|58150||PC M/M HB CLINIC|2,497.00 PEMBINA COUNTY MEDICAL CENTER|58660|LAP,LYSIS OF ADHESIONS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|58660||PC STANDARD FEE SCHEDULE|1,682.00 PEMBINA COUNTY MEDICAL CENTER|58660|LAP,LYSIS OF ADHESIONS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|58660||PC M/M HB CLINIC|1,682.00 PEMBINA COUNTY MEDICAL CENTER|58661|LAP,RMV ADNEXAL STRUCTURE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|58661||PC STANDARD FEE SCHEDULE|1,608.00 PEMBINA COUNTY MEDICAL CENTER|58661|LAP,RMV ADNEXAL STRUCTURE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|58661||PC M/M HB CLINIC|1,608.00 PEMBINA COUNTY MEDICAL CENTER|58662|LAP,FULGURATE/EXCISE LESIONS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|58662||PC STANDARD FEE SCHEDULE|1,764.00 PEMBINA COUNTY MEDICAL CENTER|58662|LAP,FULGURATE/EXCISE LESIONS|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|58662||PC M/M HB CLINIC|1,764.00 PEMBINA COUNTY MEDICAL CENTER|58670|LAP,TUBAL CAUTERY|PROFESSIONAL FEES - OPERATING ROOM [0975]|58670||PC STANDARD FEE SCHEDULE|917.00 PEMBINA COUNTY MEDICAL CENTER|58670|LAP,TUBAL CAUTERY|PROFESSIONAL FEES - OPERATING ROOM [0975]|58670||PC M/M HB CLINIC|917.00 PEMBINA COUNTY MEDICAL CENTER|58925|REMOVAL OF OVARIAN CYST(S)|PROFESSIONAL FEES - OPERATING ROOM [0975]|58925||PC STANDARD FEE SCHEDULE|1,853.00 PEMBINA COUNTY MEDICAL CENTER|58925|REMOVAL OF OVARIAN CYST(S)|PROFESSIONAL FEES - OPERATING ROOM [0975]|58925||PC M/M HB CLINIC|1,853.00 PEMBINA COUNTY MEDICAL CENTER|59409|OBSTETRICAL CARE,VAG DELIV ONLY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|59409||PC STANDARD FEE SCHEDULE|2,054.00 PEMBINA COUNTY MEDICAL CENTER|59409|OBSTETRICAL CARE,VAG DELIV ONLY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|59409||PC M/M HB CLINIC|2,054.00 PEMBINA COUNTY MEDICAL CENTER|60220|THYROID LOBECTOMY,UNILAT|PROFESSIONAL FEES - OPERATING ROOM [0975]|60220||PC STANDARD FEE SCHEDULE|1,762.00 PEMBINA COUNTY MEDICAL CENTER|60220|THYROID LOBECTOMY,UNILAT|PROFESSIONAL FEES - OPERATING ROOM [0975]|60220||PC M/M HB CLINIC|1,762.00 PEMBINA COUNTY MEDICAL CENTER|64420|INJECT NERV BLCK,INTERCOSTAL,ONE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|64420||PC STANDARD FEE SCHEDULE|173.00 PEMBINA COUNTY MEDICAL CENTER|64420|INJECT NERV BLCK,INTERCOSTAL,ONE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|64420||PC M/M HB CLINIC|173.00 PEMBINA COUNTY MEDICAL CENTER|64721|REVISE MEDIAN N/CARPAL TUNNEL SURG|PROFESSIONAL FEES - OPERATING ROOM [0975]|64721||PC STANDARD FEE SCHEDULE|1,064.00 PEMBINA COUNTY MEDICAL CENTER|64721|REVISE MEDIAN N/CARPAL TUNNEL SURG|PROFESSIONAL FEES - OPERATING ROOM [0975]|64721||PC M/M HB CLINIC|1,064.00 PEMBINA COUNTY MEDICAL CENTER|65210|REMV F.B.,EYE,EMBED CONJUNC|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|65210||PC STANDARD FEE SCHEDULE|136.00 PEMBINA COUNTY MEDICAL CENTER|65210|REMV F.B.,EYE,EMBED CONJUNC|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|65210||PC M/M HB CLINIC|136.00 PEMBINA COUNTY MEDICAL CENTER|65220|REMV F.B.,EYE,CORNEA,NO SLIT|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|65220||PC STANDARD FEE SCHEDULE|107.00 PEMBINA COUNTY MEDICAL CENTER|65220|REMV F.B.,EYE,CORNEA,NO SLIT|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|65220||PC M/M HB CLINIC|107.00 PEMBINA COUNTY MEDICAL CENTER|65222|REMV F.B.,EYE,CORNEA,SLIT LAMP|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|65222||PC STANDARD FEE SCHEDULE|135.00 PEMBINA COUNTY MEDICAL CENTER|65222|REMV F.B.,EYE,CORNEA,SLIT LAMP|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|65222||PC M/M HB CLINIC|135.00 PEMBINA COUNTY MEDICAL CENTER|67840|REMOVE EYELID LESN (NOT CHALAZION)|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|67840||PC STANDARD FEE SCHEDULE|407.00 PEMBINA COUNTY MEDICAL CENTER|67840|REMOVE EYELID LESN (NOT CHALAZION)|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|67840||PC M/M HB CLINIC|407.00 PEMBINA COUNTY MEDICAL CENTER|68400|INCISE/DRAIN TEAR GLAND|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|68400||PC STANDARD FEE SCHEDULE|345.00 PEMBINA COUNTY MEDICAL CENTER|68400|INCISE/DRAIN TEAR GLAND|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|68400||PC M/M HB CLINIC|345.00 PEMBINA COUNTY MEDICAL CENTER|68810|PROBE NASOLACRIMAL DUCT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|68810||PC STANDARD FEE SCHEDULE|487.00 PEMBINA COUNTY MEDICAL CENTER|68810|PROBE NASOLACRIMAL DUCT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|68810||PC M/M HB CLINIC|487.00 PEMBINA COUNTY MEDICAL CENTER|69000|DRAIN EXT EAR ABSC/BLOOD,SIMPLE|PROFESSIONAL FEES - CLINIC [0983]|69000||PC STANDARD FEE SCHEDULE|306.00 PEMBINA COUNTY MEDICAL CENTER|69000|DRAIN EXT EAR ABSC/BLOOD,SIMPLE|PROFESSIONAL FEES - CLINIC [0983]|69000||PC M/M HB CLINIC|306.00 PEMBINA COUNTY MEDICAL CENTER|69200|REMV EXT CANAL FOREIGN BODY|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|69200||PC STANDARD FEE SCHEDULE|149.00 PEMBINA COUNTY MEDICAL CENTER|69200|REMV EXT CANAL FOREIGN BODY|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|69200||PC M/M HB CLINIC|149.00 PEMBINA COUNTY MEDICAL CENTER|69205|REMV EXT CANAL F.B.,GEN ANESTH|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|69205||PC STANDARD FEE SCHEDULE|258.00 PEMBINA COUNTY MEDICAL CENTER|69205|REMV EXT CANAL F.B.,GEN ANESTH|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|69205||PC M/M HB CLINIC|258.00 PEMBINA COUNTY MEDICAL CENTER|69210|REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|69210||PC STANDARD FEE SCHEDULE|81.00 PEMBINA COUNTY MEDICAL CENTER|69210|REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|69210||PC M/M HB CLINIC|81.00 PEMBINA COUNTY MEDICAL CENTER|90375|RABIES IG, IM/SC|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90375||PC STANDARD FEE SCHEDULE|312.00 PEMBINA COUNTY MEDICAL CENTER|90389|TETANUS IG, IM|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90389||PC STANDARD FEE SCHEDULE|224.00 PEMBINA COUNTY MEDICAL CENTER|90396|VARICELLA-ZOSTER IG, IM|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90396||PC STANDARD FEE SCHEDULE|909.00 PEMBINA COUNTY MEDICAL CENTER|90471|IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID|PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION [0771]|90471||PC STANDARD FEE SCHEDULE|49.00 PEMBINA COUNTY MEDICAL CENTER|90472|IMMUNIZ,ADMIN,EACH ADDL|PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION [0771]|90472||PC STANDARD FEE SCHEDULE|23.00 PEMBINA COUNTY MEDICAL CENTER|90473|IMMUNIZ ADMIN,INTRANASAL/ORAL,1 VAC/TOX|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|90473||PC STANDARD FEE SCHEDULE|41.00 PEMBINA COUNTY MEDICAL CENTER|90474|IMMUNIZ ADMIN,INTRANASAL/ORAL,EACH ADDL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|90474||PC STANDARD FEE SCHEDULE|21.00 PEMBINA COUNTY MEDICAL CENTER|90632|HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90632||PC STANDARD FEE SCHEDULE|103.00 PEMBINA COUNTY MEDICAL CENTER|90633|HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE|PHARMACY - GENERAL CLASSIFICATION [0250]|90633||PC STANDARD FEE SCHEDULE|47.75 PEMBINA COUNTY MEDICAL CENTER|90636|HEPA/HEPB VACCINE ADULT IM|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90636||PC STANDARD FEE SCHEDULE|145.00 PEMBINA COUNTY MEDICAL CENTER|90647|HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE|PHARMACY - GENERAL CLASSIFICATION [0250]|90647||PC STANDARD FEE SCHEDULE|37.00 PEMBINA COUNTY MEDICAL CENTER|90648|HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE|PHARMACY - GENERAL CLASSIFICATION [0250]|90648||PC STANDARD FEE SCHEDULE|47.00 PEMBINA COUNTY MEDICAL CENTER|90655|IIV3 VACC PRESRV FREE 0.25 ML DOSAGE IM USE|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90655||PC STANDARD FEE SCHEDULE|31.00 PEMBINA COUNTY MEDICAL CENTER|90657|IIV3 VACCINE SPLIT VIRUS 0.25 ML DOSAGE IM USE|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90657||PC STANDARD FEE SCHEDULE|31.00 PEMBINA COUNTY MEDICAL CENTER|90658|IIV3 VACCINE SPLIT VIRUS 0.5 ML DOSAGE IM USE|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90658||PC STANDARD FEE SCHEDULE|31.00 PEMBINA COUNTY MEDICAL CENTER|90660|LAIV3 VACCINE LIVE FOR INTRANASAL USE|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90660||PC STANDARD FEE SCHEDULE|31.00 PEMBINA COUNTY MEDICAL CENTER|90675|RABIES VACCINE, IM|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90675||PC STANDARD FEE SCHEDULE|880.00 PEMBINA COUNTY MEDICAL CENTER|90680|RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90680||PC STANDARD FEE SCHEDULE|113.50 PEMBINA COUNTY MEDICAL CENTER|90698|DTAP-IPV/HIB VACCINE FOR INTRAMUSCULAR USE|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90698||PC STANDARD FEE SCHEDULE|125.00 PEMBINA COUNTY MEDICAL CENTER|90700|PR DTAP IMMUNIZATION, IM|PHARMACY - GENERAL CLASSIFICATION [0250]|90700||PC STANDARD FEE SCHEDULE|37.00 PEMBINA COUNTY MEDICAL CENTER|90707|MMR VIRUS IMMUNIZATION, SUBCUT|PHARMACY - GENERAL CLASSIFICATION [0250]|90707||PC STANDARD FEE SCHEDULE|62.00 PEMBINA COUNTY MEDICAL CENTER|90710|COMBINED VACCINE,MMR+VARICELLA,SQ|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90710||PC STANDARD FEE SCHEDULE|294.75 PEMBINA COUNTY MEDICAL CENTER|90713|POLIOMYELITIS IMMUNIZATN,INACTV,SQ|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90713||PC STANDARD FEE SCHEDULE|51.00 PEMBINA COUNTY MEDICAL CENTER|90715|TDAP VACCINE >7 IM|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90715||PC STANDARD FEE SCHEDULE|55.00 PEMBINA COUNTY MEDICAL CENTER|90716|VAR VACCINE LIVE FOR SUBCUTANEOUS USE|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90716||PC STANDARD FEE SCHEDULE|185.00 PEMBINA COUNTY MEDICAL CENTER|90723|DTAP-HEPB-IPV VACCINE INTRAMUSCULAR|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90723||PC STANDARD FEE SCHEDULE|109.00 PEMBINA COUNTY MEDICAL CENTER|90732|PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90732||PC STANDARD FEE SCHEDULE|139.00 PEMBINA COUNTY MEDICAL CENTER|90733|MPSV4 VACCINE GROUPS ACYW-135 SUBQ USE|PHARMACY - GENERAL CLASSIFICATION [0250]|90733||PC STANDARD FEE SCHEDULE|176.00 PEMBINA COUNTY MEDICAL CENTER|90734|MCV4/MENACWY CONJ VACC GRPS ACYW-135 IM USE|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90734||PC STANDARD FEE SCHEDULE|176.00 PEMBINA COUNTY MEDICAL CENTER|90744|HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90744||PC STANDARD FEE SCHEDULE|26.00 PEMBINA COUNTY MEDICAL CENTER|90746|HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90746||PC STANDARD FEE SCHEDULE|84.00 PEMBINA COUNTY MEDICAL CENTER|90747|HEPB VACCINE DIALYSIS/IMMUNSUP PAT 4 DOSE IM|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90747||PC STANDARD FEE SCHEDULE|160.00 PEMBINA COUNTY MEDICAL CENTER|90748|HIB-HEPB VACCINE FOR INTRAMUSCULAR USE|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90748||PC STANDARD FEE SCHEDULE|70.00 PEMBINA COUNTY MEDICAL CENTER|92950|HEART/LUNG RESUSCITATION (CPR)|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|92950||PC STANDARD FEE SCHEDULE|450.00 PEMBINA COUNTY MEDICAL CENTER|92950|HEART/LUNG RESUSCITATION (CPR)|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|92950||PC M/M HB CLINIC|450.00 PEMBINA COUNTY MEDICAL CENTER|92960|CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|92960||PC STANDARD FEE SCHEDULE|294.00 PEMBINA COUNTY MEDICAL CENTER|92960|CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|92960||PC M/M HB CLINIC|294.00 PEMBINA COUNTY MEDICAL CENTER|93016|CV STRS TST XERS&/OR RX CONT ECG W/O I&R|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|93016||PC STANDARD FEE SCHEDULE|54.00 PEMBINA COUNTY MEDICAL CENTER|93016|CV STRS TST XERS&/OR RX CONT ECG W/O I&R|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|93016||PC M/M HB CLINIC|54.00 PEMBINA COUNTY MEDICAL CENTER|93018|CARDIAC STRESS TST,INTERP/REPT ONLY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|93018||PC STANDARD FEE SCHEDULE|37.00 PEMBINA COUNTY MEDICAL CENTER|93018|CARDIAC STRESS TST,INTERP/REPT ONLY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|93018||PC M/M HB CLINIC|37.00 PEMBINA COUNTY MEDICAL CENTER|93784|AMBULATORY BP MONITORING|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|93784||PC STANDARD FEE SCHEDULE|153.00 PEMBINA COUNTY MEDICAL CENTER|94640|PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|94640||PC STANDARD FEE SCHEDULE|49.00 PEMBINA COUNTY MEDICAL CENTER|94640|PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|94640||PC M/M HB CLINIC|49.00 PEMBINA COUNTY MEDICAL CENTER|99141|SEDATION, IV/IM OR INHALANT||99141||PC M/M HB CLINIC|258.00 PEMBINA COUNTY MEDICAL CENTER|99201|OFFICE OUTPATIENT NEW|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99201||PC STANDARD FEE SCHEDULE|65.00 PEMBINA COUNTY MEDICAL CENTER|99201|OFFICE OUTPATIENT NEW|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99201||PC M/M HB CLINIC|65.00 PEMBINA COUNTY MEDICAL CENTER|99202|OFFICE OUTPATIENT NEW|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99202||PC STANDARD FEE SCHEDULE|122.00 PEMBINA COUNTY MEDICAL CENTER|99202|OFFICE OUTPATIENT NEW|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99202||PC M/M HB CLINIC|122.00 PEMBINA COUNTY MEDICAL CENTER|99203|OFFICE OUTPATIENT NEW|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99203||PC STANDARD FEE SCHEDULE|184.00 PEMBINA COUNTY MEDICAL CENTER|99203|OFFICE OUTPATIENT NEW|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99203||PC M/M HB CLINIC|184.00 PEMBINA COUNTY MEDICAL CENTER|99204|OFFICE OUTPATIENT NEW|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99204||PC STANDARD FEE SCHEDULE|405.00 PEMBINA COUNTY MEDICAL CENTER|99205|OFFICE OUTPATIENT NEW|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99205||PC STANDARD FEE SCHEDULE|502.00 PEMBINA COUNTY MEDICAL CENTER|99211|OFFICE OUTPATIENT VISIT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99211||PC STANDARD FEE SCHEDULE|51.00 PEMBINA COUNTY MEDICAL CENTER|99211|OFFICE OUTPATIENT VISIT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99211||PC M/M HB CLINIC|51.00 PEMBINA COUNTY MEDICAL CENTER|99212|OFFICE OUTPATIENT VISIT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99212||PC STANDARD FEE SCHEDULE|61.00 PEMBINA COUNTY MEDICAL CENTER|99212|OFFICE OUTPATIENT VISIT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99212||PC M/M HB CLINIC|61.00 PEMBINA COUNTY MEDICAL CENTER|99213|OFFICE OUTPATIENT VISIT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99213||PC STANDARD FEE SCHEDULE|124.00 PEMBINA COUNTY MEDICAL CENTER|99213|OFFICE OUTPATIENT VISIT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99213||PC M/M HB CLINIC|124.00 PEMBINA COUNTY MEDICAL CENTER|99214|OFFICE OUTPATIENT VISIT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99214||PC STANDARD FEE SCHEDULE|189.00 PEMBINA COUNTY MEDICAL CENTER|99214|OFFICE OUTPATIENT VISIT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99214||PC M/M HB CLINIC|189.00 PEMBINA COUNTY MEDICAL CENTER|99215|OFFICE OUTPATIENT VISIT|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99215||PC STANDARD FEE SCHEDULE|352.00 PEMBINA COUNTY MEDICAL CENTER|99217|OBSERVATION CARE DISCHARGE MANAGEMENT|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99217||PC STANDARD FEE SCHEDULE|175.00 PEMBINA COUNTY MEDICAL CENTER|99217|OBSERVATION CARE DISCHARGE MANAGEMENT|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99217||PC M/M HB CLINIC|175.00 PEMBINA COUNTY MEDICAL CENTER|99218|INITIAL OBSERVATION CARE/DAY 30 MINUTES|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99218||PC STANDARD FEE SCHEDULE|239.00 PEMBINA COUNTY MEDICAL CENTER|99218|INITIAL OBSERVATION CARE/DAY 30 MINUTES|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99218||PC M/M HB CLINIC|239.00 PEMBINA COUNTY MEDICAL CENTER|99219|INITIAL OBSERVATION CARE/DAY 50 MINUTES|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99219||PC STANDARD FEE SCHEDULE|324.00 PEMBINA COUNTY MEDICAL CENTER|99219|INITIAL OBSERVATION CARE/DAY 50 MINUTES|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99219||PC M/M HB CLINIC|324.00 PEMBINA COUNTY MEDICAL CENTER|99220|INITIAL OBSERVATION CARE/DAY 70 MINUTES|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99220||PC STANDARD FEE SCHEDULE|445.00 PEMBINA COUNTY MEDICAL CENTER|99220|INITIAL OBSERVATION CARE/DAY 70 MINUTES|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99220||PC M/M HB CLINIC|445.00 PEMBINA COUNTY MEDICAL CENTER|99221|INITIAL HOSPITAL CARE/DAY|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99221||PC STANDARD FEE SCHEDULE|244.00 PEMBINA COUNTY MEDICAL CENTER|99221|INITIAL HOSPITAL CARE/DAY|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99221||PC M/M HB CLINIC|244.00 PEMBINA COUNTY MEDICAL CENTER|99222|INITIAL HOSPITAL CARE/DAY|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99222||PC STANDARD FEE SCHEDULE|331.00 PEMBINA COUNTY MEDICAL CENTER|99222|INITIAL HOSPITAL CARE/DAY|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99222||PC M/M HB CLINIC|331.00 PEMBINA COUNTY MEDICAL CENTER|99223|INITIAL HOSPITAL CARE/DAY|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99223||PC STANDARD FEE SCHEDULE|487.00 PEMBINA COUNTY MEDICAL CENTER|99223|INITIAL HOSPITAL CARE/DAY|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99223||PC M/M HB CLINIC|487.00 PEMBINA COUNTY MEDICAL CENTER|99231|SBSQ HOSPITAL CARE/DAY|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99231||PC STANDARD FEE SCHEDULE|95.00 PEMBINA COUNTY MEDICAL CENTER|99231|SBSQ HOSPITAL CARE/DAY|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99231||PC M/M HB CLINIC|95.00 PEMBINA COUNTY MEDICAL CENTER|99232|SBSQ HOSPITAL CARE/DAY|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99232||PC STANDARD FEE SCHEDULE|174.00 PEMBINA COUNTY MEDICAL CENTER|99232|SBSQ HOSPITAL CARE/DAY|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99232||PC M/M HB CLINIC|174.00 PEMBINA COUNTY MEDICAL CENTER|99233|SBSQ HOSPITAL CARE/DAY|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99233||PC STANDARD FEE SCHEDULE|249.00 PEMBINA COUNTY MEDICAL CENTER|99233|SBSQ HOSPITAL CARE/DAY|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99233||PC M/M HB CLINIC|249.00 PEMBINA COUNTY MEDICAL CENTER|99234|OBSERVATION/INPATIENT HOSPITAL CARE 40 MINUTES|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99234||PC STANDARD FEE SCHEDULE|323.00 PEMBINA COUNTY MEDICAL CENTER|99234|OBSERVATION/INPATIENT HOSPITAL CARE 40 MINUTES|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99234||PC M/M HB CLINIC|323.00 PEMBINA COUNTY MEDICAL CENTER|99235|OBSERVATION/INPATIENT HOSPITAL CARE 50 MINUTES|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99235||PC STANDARD FEE SCHEDULE|404.00 PEMBINA COUNTY MEDICAL CENTER|99235|OBSERVATION/INPATIENT HOSPITAL CARE 50 MINUTES|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99235||PC M/M HB CLINIC|404.00 PEMBINA COUNTY MEDICAL CENTER|99236|OBSERVATION/INPATIENT HOSPITAL CARE 55 MINUTES|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99236||PC STANDARD FEE SCHEDULE|523.00 PEMBINA COUNTY MEDICAL CENTER|99236|OBSERVATION/INPATIENT HOSPITAL CARE 55 MINUTES|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99236||PC M/M HB CLINIC|523.00 PEMBINA COUNTY MEDICAL CENTER|99238|HOSPITAL DISCHARGE DAY,<30 MIN|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99238||PC STANDARD FEE SCHEDULE|175.00 PEMBINA COUNTY MEDICAL CENTER|99238|HOSPITAL DISCHARGE DAY,<30 MIN|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99238||PC M/M HB CLINIC|175.00 PEMBINA COUNTY MEDICAL CENTER|99239|HOSPITAL DISCHARGE DAY,>30 MIN|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99239||PC STANDARD FEE SCHEDULE|258.00 PEMBINA COUNTY MEDICAL CENTER|99239|HOSPITAL DISCHARGE DAY,>30 MIN|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99239||PC M/M HB CLINIC|258.00 PEMBINA COUNTY MEDICAL CENTER|99241|OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99241||PC STANDARD FEE SCHEDULE|81.00 PEMBINA COUNTY MEDICAL CENTER|99241|OFFICE CONSULTATION NEW/ESTAB PATIENT 15 MIN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99241||PC M/M HB CLINIC|81.00 PEMBINA COUNTY MEDICAL CENTER|99242|OFFICE CONSULTATION NEW/ESTAB PATIENT 30 MIN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99242||PC STANDARD FEE SCHEDULE|168.00 PEMBINA COUNTY MEDICAL CENTER|99242|OFFICE CONSULTATION NEW/ESTAB PATIENT 30 MIN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99242||PC M/M HB CLINIC|168.00 PEMBINA COUNTY MEDICAL CENTER|99243|OFFICE CONSULTATION NEW/ESTAB PATIENT 40 MIN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99243||PC STANDARD FEE SCHEDULE|233.00 PEMBINA COUNTY MEDICAL CENTER|99243|OFFICE CONSULTATION NEW/ESTAB PATIENT 40 MIN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99243||PC M/M HB CLINIC|233.00 PEMBINA COUNTY MEDICAL CENTER|99244|OFFICE CONSULTATION NEW/ESTAB PATIENT 60 MIN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99244||PC STANDARD FEE SCHEDULE|367.00 PEMBINA COUNTY MEDICAL CENTER|99244|OFFICE CONSULTATION NEW/ESTAB PATIENT 60 MIN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99244||PC M/M HB CLINIC|367.00 PEMBINA COUNTY MEDICAL CENTER|99245|OFFICE CONSULTATION NEW/ESTAB PATIENT 80 MIN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99245||PC STANDARD FEE SCHEDULE|456.00 PEMBINA COUNTY MEDICAL CENTER|99245|OFFICE CONSULTATION NEW/ESTAB PATIENT 80 MIN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99245||PC M/M HB CLINIC|456.00 PEMBINA COUNTY MEDICAL CENTER|99251|INITL INPATIENT CONSULT NEW/ESTAB PT 20 MIN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99251||PC STANDARD FEE SCHEDULE|116.00 PEMBINA COUNTY MEDICAL CENTER|99251|INITL INPATIENT CONSULT NEW/ESTAB PT 20 MIN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99251||PC M/M HB CLINIC|116.00 PEMBINA COUNTY MEDICAL CENTER|99252|INITL INPATIENT CONSULT NEW/ESTAB PT 40 MIN|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|99252||PC STANDARD FEE SCHEDULE|180.00 PEMBINA COUNTY MEDICAL CENTER|99252|INITL INPATIENT CONSULT NEW/ESTAB PT 40 MIN|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|99252||PC M/M HB CLINIC|180.00 PEMBINA COUNTY MEDICAL CENTER|99253|INITL INPATIENT CONSULT NEW/ESTAB PT 55 MIN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99253||PC STANDARD FEE SCHEDULE|272.00 PEMBINA COUNTY MEDICAL CENTER|99253|INITL INPATIENT CONSULT NEW/ESTAB PT 55 MIN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99253||PC M/M HB CLINIC|272.00 PEMBINA COUNTY MEDICAL CENTER|99254|INITL INPATIENT CONSULT NEW/ESTAB PT 80 MIN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99254||PC STANDARD FEE SCHEDULE|393.00 PEMBINA COUNTY MEDICAL CENTER|99254|INITL INPATIENT CONSULT NEW/ESTAB PT 80 MIN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99254||PC M/M HB CLINIC|393.00 PEMBINA COUNTY MEDICAL CENTER|99255|INITIAL INPATIENT CONSULT NEW/ESTAB PT 110 MIN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99255||PC STANDARD FEE SCHEDULE|491.00 PEMBINA COUNTY MEDICAL CENTER|99255|INITIAL INPATIENT CONSULT NEW/ESTAB PT 110 MIN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99255||PC M/M HB CLINIC|491.00 PEMBINA COUNTY MEDICAL CENTER|99281|EMERGENCY DEPARTMENT VISIT LIMITED/MINOR PROB|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|99281||PC STANDARD FEE SCHEDULE|51.00 PEMBINA COUNTY MEDICAL CENTER|99281|EMERGENCY DEPARTMENT VISIT LIMITED/MINOR PROB|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|99281||PC M/M HB CLINIC|51.00 PEMBINA COUNTY MEDICAL CENTER|99282|EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|99282||PC STANDARD FEE SCHEDULE|101.00 PEMBINA COUNTY MEDICAL CENTER|99282|EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|99282||PC M/M HB CLINIC|101.00 PEMBINA COUNTY MEDICAL CENTER|99283|EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|99283||PC STANDARD FEE SCHEDULE|149.00 PEMBINA COUNTY MEDICAL CENTER|99283|EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|99283||PC M/M HB CLINIC|149.00 PEMBINA COUNTY MEDICAL CENTER|99284|EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|99284||PC STANDARD FEE SCHEDULE|283.00 PEMBINA COUNTY MEDICAL CENTER|99284|EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|99284||PC M/M HB CLINIC|283.00 PEMBINA COUNTY MEDICAL CENTER|99285|EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNCJ|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|99285||PC STANDARD FEE SCHEDULE|413.00 PEMBINA COUNTY MEDICAL CENTER|99285|EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNCJ|PROFESSIONAL FEES - EMERGENCY ROOM [0981]|99285||PC M/M HB CLINIC|413.00 PEMBINA COUNTY MEDICAL CENTER|99291|CRITICAL CARE, E/M 30-74 MINUTES|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99291||PC STANDARD FEE SCHEDULE|536.00 PEMBINA COUNTY MEDICAL CENTER|99291|CRITICAL CARE, E/M 30-74 MINUTES|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99291||PC M/M HB CLINIC|536.00 PEMBINA COUNTY MEDICAL CENTER|99292|CRITICAL CARE, ADDL 30 MIN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99292||PC STANDARD FEE SCHEDULE|270.00 PEMBINA COUNTY MEDICAL CENTER|99292|CRITICAL CARE, ADDL 30 MIN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99292||PC M/M HB CLINIC|270.00 PEMBINA COUNTY MEDICAL CENTER|99315|NURSING FAC DISCHRGE DAY,1-30 MIN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99315||PC STANDARD FEE SCHEDULE|176.00 PEMBINA COUNTY MEDICAL CENTER|99315|NURSING FAC DISCHRGE DAY,1-30 MIN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99315||PC M/M HB CLINIC|176.00 PEMBINA COUNTY MEDICAL CENTER|99316|NURSING FAC DISCHRGE DAY,MORE 30 MIN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99316||PC STANDARD FEE SCHEDULE|251.00 PEMBINA COUNTY MEDICAL CENTER|99316|NURSING FAC DISCHRGE DAY,MORE 30 MIN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|99316||PC M/M HB CLINIC|251.00 PEMBINA COUNTY MEDICAL CENTER|G0008|ADMIN INFLUENZA VIRUS VAC|PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION [0771]|G0008||PC STANDARD FEE SCHEDULE|9.00 PEMBINA COUNTY MEDICAL CENTER|G0009|ADMIN PNEUMOCOCCAL VACCINE|PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION [0771]|G0009||PC STANDARD FEE SCHEDULE|8.00 PEMBINA COUNTY MEDICAL CENTER|G0010|ADMIN HEPATITIS B VACCINE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|G0010||PC STANDARD FEE SCHEDULE|42.00 PEMBINA COUNTY MEDICAL CENTER|G0105|COLORECTAL SCRN; HI RISK IND|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|G0105||PC STANDARD FEE SCHEDULE|542.00 PEMBINA COUNTY MEDICAL CENTER|G0105|COLORECTAL SCRN; HI RISK IND|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|G0105||PC M/M HB CLINIC|542.00 PEMBINA COUNTY MEDICAL CENTER|G0121|COLON CA SCRN NOT HI RSK IND|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|G0121||PC STANDARD FEE SCHEDULE|542.00 PEMBINA COUNTY MEDICAL CENTER|G0121|COLON CA SCRN NOT HI RSK IND|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|G0121||PC M/M HB CLINIC|542.00 PEMBINA COUNTY MEDICAL CENTER|J0690|CEFAZOLIN SODIUM INJECTION|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J0690||PC STANDARD FEE SCHEDULE|13.00 PEMBINA COUNTY MEDICAL CENTER|J0696|CEFTRIAXONE SODIUM INJECTION|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J0696||PC STANDARD FEE SCHEDULE|7.00 PEMBINA COUNTY MEDICAL CENTER|J1040|METHYLPREDNISOLONE 80 MG INJ|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J1040||PC STANDARD FEE SCHEDULE|35.00 PEMBINA COUNTY MEDICAL CENTER|J1100|DEXAMETHASONE 1MG INJ|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J1100||PC STANDARD FEE SCHEDULE|3.00 PEMBINA COUNTY MEDICAL CENTER|J1200|DIPHENHYDRAMINE HCL INJECTIO|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J1200||PC STANDARD FEE SCHEDULE|26.00 PEMBINA COUNTY MEDICAL CENTER|J1610|GLUCAGON HYDROCHLORIDE/1 MG|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J1610||PC STANDARD FEE SCHEDULE|504.00 PEMBINA COUNTY MEDICAL CENTER|J1630|HALOPERIDOL INJECTION|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J1630||PC STANDARD FEE SCHEDULE|38.00 PEMBINA COUNTY MEDICAL CENTER|J1650|INJ ENOXAPARIN SODIUM|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J1650||PC STANDARD FEE SCHEDULE|26.00 PEMBINA COUNTY MEDICAL CENTER|J1670|HUMAN TETANUS IG UP TO 250 UNITS|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J1670||PC STANDARD FEE SCHEDULE|620.75 PEMBINA COUNTY MEDICAL CENTER|J1885|KETOROLAC TROMETHAMINE INJ|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J1885||PC STANDARD FEE SCHEDULE|7.00 PEMBINA COUNTY MEDICAL CENTER|J2060|LORAZEPAM INJECTION|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J2060||PC STANDARD FEE SCHEDULE|26.00 PEMBINA COUNTY MEDICAL CENTER|J2175|MEPERIDINE HYDROCHL /100 MG|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J2175||PC STANDARD FEE SCHEDULE|29.00 PEMBINA COUNTY MEDICAL CENTER|J2270|MORPHINE SULFATE INJECTION|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J2270||PC STANDARD FEE SCHEDULE|26.00 PEMBINA COUNTY MEDICAL CENTER|J2310|INJ NALOXONE HYDROCHLORIDE|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J2310||PC STANDARD FEE SCHEDULE|66.00 PEMBINA COUNTY MEDICAL CENTER|J2405|ONDANSETRON HCL INJECTION|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J2405||PC STANDARD FEE SCHEDULE|7.00 PEMBINA COUNTY MEDICAL CENTER|J2505|INJECTION, PEGFILGRASTIM 6MG|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J2505||PC STANDARD FEE SCHEDULE|12,843.00 PEMBINA COUNTY MEDICAL CENTER|J2550|PROMETHAZINE HCL INJECTION|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J2550||PC STANDARD FEE SCHEDULE|26.00 PEMBINA COUNTY MEDICAL CENTER|J2930|METHYLPREDNISOLONE INJECTION|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J2930||PC STANDARD FEE SCHEDULE|37.00 PEMBINA COUNTY MEDICAL CENTER|J3030|IMITREX INJ 6MG|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J3030||PC STANDARD FEE SCHEDULE|375.00 PEMBINA COUNTY MEDICAL CENTER|J3120|TESTOSTERONE ENANTHATE INJ|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J3120||PC STANDARD FEE SCHEDULE|13.00 PEMBINA COUNTY MEDICAL CENTER|J3301|TRIAMCINOLONE ACETONIDE INJ|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J3301||PC STANDARD FEE SCHEDULE|7.00 PEMBINA COUNTY MEDICAL CENTER|J3360|DIAZEPAM INJECTION|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J3360||PC STANDARD FEE SCHEDULE|67.00 PEMBINA COUNTY MEDICAL CENTER|J3410|HYDROXYZINE HCL INJECTION|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J3410||PC STANDARD FEE SCHEDULE|31.00 PEMBINA COUNTY MEDICAL CENTER|J3420|VITAMIN B12 INJECTION|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J3420||PC STANDARD FEE SCHEDULE|33.00 PEMBINA COUNTY MEDICAL CENTER|J3430|VITAMIN K PHYTONADIONE INJ|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J3430||PC STANDARD FEE SCHEDULE|2.00 PEMBINA COUNTY MEDICAL CENTER|15830|EXCISE EXCESS SKIN TISSUE,ABDOMEN|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|15830||PC STANDARD FEE SCHEDULE|2,848.00 PEMBINA COUNTY MEDICAL CENTER|19300|MASTECTOMY FOR GYNECOMASTIA|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|19300||PC STANDARD FEE SCHEDULE|1,026.00 PEMBINA COUNTY MEDICAL CENTER|19300|MASTECTOMY FOR GYNECOMASTIA|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|19300||PC M/M HB CLINIC|1,026.00 PEMBINA COUNTY MEDICAL CENTER|19302|MASTECTOMY,PARTIAL, WITH AXILLARY LYMPHADENECTOMY|PROFESSIONAL FEES - OPERATING ROOM [0975]|19302||PC STANDARD FEE SCHEDULE|2,217.00 PEMBINA COUNTY MEDICAL CENTER|19302|MASTECTOMY,PARTIAL, WITH AXILLARY LYMPHADENECTOMY|PROFESSIONAL FEES - OPERATING ROOM [0975]|19302||PC M/M HB CLINIC|2,217.00 PEMBINA COUNTY MEDICAL CENTER|19303|MASTECTOMY, SIMPLE, COMPLETE|PROFESSIONAL FEES - OPERATING ROOM [0975]|19303||PC STANDARD FEE SCHEDULE|2,493.00 PEMBINA COUNTY MEDICAL CENTER|19303|MASTECTOMY, SIMPLE, COMPLETE|PROFESSIONAL FEES - OPERATING ROOM [0975]|19303||PC M/M HB CLINIC|2,493.00 PEMBINA COUNTY MEDICAL CENTER|19305|MASTECTOMY, RADICAL|PROFESSIONAL FEES - OPERATING ROOM [0975]|19305||PC STANDARD FEE SCHEDULE|2,791.00 PEMBINA COUNTY MEDICAL CENTER|19305|MASTECTOMY, RADICAL|PROFESSIONAL FEES - OPERATING ROOM [0975]|19305||PC M/M HB CLINIC|2,791.00 PEMBINA COUNTY MEDICAL CENTER|19307|MASTECTOMY, MODIFIED RADICAL|PROFESSIONAL FEES - OPERATING ROOM [0975]|19307||PC STANDARD FEE SCHEDULE|2,956.00 PEMBINA COUNTY MEDICAL CENTER|19307|MASTECTOMY, MODIFIED RADICAL|PROFESSIONAL FEES - OPERATING ROOM [0975]|19307||PC M/M HB CLINIC|2,956.00 PEMBINA COUNTY MEDICAL CENTER|49402|REMOVE PERITONEAL FOREIGN BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|49402||PC STANDARD FEE SCHEDULE|2,115.00 PEMBINA COUNTY MEDICAL CENTER|49402|REMOVE PERITONEAL FOREIGN BODY|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|49402||PC M/M HB CLINIC|2,115.00 PEMBINA COUNTY MEDICAL CENTER|32551|TUBE THORACOSTOMY INCLUDES WATER SEAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|32551||PC STANDARD FEE SCHEDULE|438.00 PEMBINA COUNTY MEDICAL CENTER|32551|TUBE THORACOSTOMY INCLUDES WATER SEAL|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|32551||PC M/M HB CLINIC|438.00 PEMBINA COUNTY MEDICAL CENTER|49203|EXCISION/DESTRUCTION OPEN ABDOMINAL TUMORS 5 CM|PROFESSIONAL FEES - OPERATING ROOM [0975]|49203||PC STANDARD FEE SCHEDULE|2,943.00 PEMBINA COUNTY MEDICAL CENTER|49203|EXCISION/DESTRUCTION OPEN ABDOMINAL TUMORS 5 CM|PROFESSIONAL FEES - OPERATING ROOM [0975]|49203||PC M/M HB CLINIC|2,943.00 PEMBINA COUNTY MEDICAL CENTER|90662|IIV VACCINE PRESERV FREE INCREASED AG COUNT IM|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90662||PC STANDARD FEE SCHEDULE|39.00 PEMBINA COUNTY MEDICAL CENTER|1210000|ROOM & NURSING|ROOM & BOARD - SEMI-PRIVATE TWO BED (MEDICAL OR GENERAL) - MEDICAL/SURGICAL/GYN [0121]|||PC STANDARD FEE SCHEDULE|1,191.00 PEMBINA COUNTY MEDICAL CENTER|2000000|HC ICU ROOM & NURSING|INTENSIVE CARE - GENERAL CLASSIFICATION [0200]|||PC STANDARD FEE SCHEDULE|2,374.00 PEMBINA COUNTY MEDICAL CENTER|2550000|HC GADOLINIUM INJ,PER ML|PHARMACY - DRUGS INCIDENT TO RADIOLOGY [0255]|A9579||PC STANDARD FEE SCHEDULE|12.00 PEMBINA COUNTY MEDICAL CENTER|2550001|HC LOCM 100-199 MG/ML IODINE,1ML|PHARMACY - DRUGS INCIDENT TO RADIOLOGY [0255]|Q9965||PC STANDARD FEE SCHEDULE|4.00 PEMBINA COUNTY MEDICAL CENTER|2550002|HC LOCM 200-299 MG/ML IODINE,1ML|PHARMACY - DRUGS INCIDENT TO RADIOLOGY [0255]|Q9966||PC STANDARD FEE SCHEDULE|3.00 PEMBINA COUNTY MEDICAL CENTER|2550003|CONTRAST MATERIAL|PHARMACY - DRUGS INCIDENT TO RADIOLOGY [0255]|Q9967||PC STANDARD FEE SCHEDULE|3.00 PEMBINA COUNTY MEDICAL CENTER|2710019|HC ER OXYGEN|MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY [0271]|||PC STANDARD FEE SCHEDULE|31.00 PEMBINA COUNTY MEDICAL CENTER|2710020|HC OXYGEN PER DAY|MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY [0271]|||PC STANDARD FEE SCHEDULE|306.00 PEMBINA COUNTY MEDICAL CENTER|3200228|XR-MANDIBLE 4+ VIEWS|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|70110||PC STANDARD FEE SCHEDULE|111.00 PEMBINA COUNTY MEDICAL CENTER|3200004|XR-FACIAL BONES 3+ VIEWS|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|70150||PC STANDARD FEE SCHEDULE|123.00 PEMBINA COUNTY MEDICAL CENTER|3200005|XR-NOSE BONES 3+ VIEWS|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|70160||PC STANDARD FEE SCHEDULE|102.00 PEMBINA COUNTY MEDICAL CENTER|3200006|HC ORBITS MIN 4 VIEWS|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|70200||PC STANDARD FEE SCHEDULE|123.00 PEMBINA COUNTY MEDICAL CENTER|3200008|XR-SINUSES 3+ VIEWS|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|70220||PC STANDARD FEE SCHEDULE|111.00 PEMBINA COUNTY MEDICAL CENTER|3200009|XR-SKULL <4 VIEWS|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|70250||PC STANDARD FEE SCHEDULE|103.00 PEMBINA COUNTY MEDICAL CENTER|3200010|XR-SKULL 4+ VIEWS|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|70260||PC STANDARD FEE SCHEDULE|125.00 PEMBINA COUNTY MEDICAL CENTER|3200011|XR-TMJ|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|70330||PC STANDARD FEE SCHEDULE|149.00 PEMBINA COUNTY MEDICAL CENTER|3200230|HC STERNO-CLAV JTS MIN 3 V|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|71130||PC STANDARD FEE SCHEDULE|108.00 PEMBINA COUNTY MEDICAL CENTER|3200014|HC CMPLX DYNAMIC PHARYNGEAL|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|70371||PC STANDARD FEE SCHEDULE|216.00 PEMBINA COUNTY MEDICAL CENTER|3200232|XR-SPINE SINGLE VIEW|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|72020||PC STANDARD FEE SCHEDULE|67.00 PEMBINA COUNTY MEDICAL CENTER|3200233|XR-SPINE 2/3 VIEWS|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|72040||PC STANDARD FEE SCHEDULE|114.00 PEMBINA COUNTY MEDICAL CENTER|3200017|XR-SPINE 4/5 VIEWS|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|72050||PC STANDARD FEE SCHEDULE|153.00 PEMBINA COUNTY MEDICAL CENTER|3200018|XR-SPINE 6+ VIEWS|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|72052||PC STANDARD FEE SCHEDULE|202.00 PEMBINA COUNTY MEDICAL CENTER|3200020|XR-THORACIC SPINE 3 VIEWS|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|72072||PC STANDARD FEE SCHEDULE|109.00 PEMBINA COUNTY MEDICAL CENTER|3200022|XR-TRUNK SPINE 2 VIEWS|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|72080||PC STANDARD FEE SCHEDULE|103.00 PEMBINA COUNTY MEDICAL CENTER|3200024|XR-LUMBAR SPINE 2 VIEWS|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|72100||PC STANDARD FEE SCHEDULE|104.00 PEMBINA COUNTY MEDICAL CENTER|3200025|XR-LUMBAR SPINE|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|72110||PC STANDARD FEE SCHEDULE|141.00 PEMBINA COUNTY MEDICAL CENTER|3200026|XR-LOWER SPINE|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|72114||PC STANDARD FEE SCHEDULE|197.00 PEMBINA COUNTY MEDICAL CENTER|3200028|XRAY PELVIS|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|72170||PC STANDARD FEE SCHEDULE|72.00 PEMBINA COUNTY MEDICAL CENTER|3200029|HC PELVIS MINIMUM 3 VIEWS|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|72190||PC STANDARD FEE SCHEDULE|129.00 PEMBINA COUNTY MEDICAL CENTER|3200031|HC SACROILIAC JOINTS|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|72202||PC STANDARD FEE SCHEDULE|104.00 PEMBINA COUNTY MEDICAL CENTER|3200032|XRAY SACRUM & COCCYX|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|72220||PC STANDARD FEE SCHEDULE|83.00 PEMBINA COUNTY MEDICAL CENTER|3200041|XRAY CLAVICLE|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73000||PC STANDARD FEE SCHEDULE|84.00 PEMBINA COUNTY MEDICAL CENTER|3200042|HC SCAPULA|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73010||PC STANDARD FEE SCHEDULE|90.00 PEMBINA COUNTY MEDICAL CENTER|3200043|XRAY SHOULDER|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73020||PC STANDARD FEE SCHEDULE|68.00 PEMBINA COUNTY MEDICAL CENTER|3200044|XRAY SHOULDER|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73030||PC STANDARD FEE SCHEDULE|86.00 PEMBINA COUNTY MEDICAL CENTER|3200046|XRAY AC JOINTS|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73050||PC STANDARD FEE SCHEDULE|118.00 PEMBINA COUNTY MEDICAL CENTER|3200047|XRAY HUMERUS|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73060||PC STANDARD FEE SCHEDULE|84.00 PEMBINA COUNTY MEDICAL CENTER|3200048|XRAY ELBOW|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73070||PC STANDARD FEE SCHEDULE|84.00 PEMBINA COUNTY MEDICAL CENTER|3200049|XRAY ELBOW|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73080||PC STANDARD FEE SCHEDULE|104.00 PEMBINA COUNTY MEDICAL CENTER|3200051|XRAY FOREARM|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73090||PC STANDARD FEE SCHEDULE|81.00 PEMBINA COUNTY MEDICAL CENTER|3200052|HC CHILD UPPER EXTREMITY|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73092||PC STANDARD FEE SCHEDULE|82.00 PEMBINA COUNTY MEDICAL CENTER|3200053|XRAY WRIST|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73100||PC STANDARD FEE SCHEDULE|92.00 PEMBINA COUNTY MEDICAL CENTER|3200054|XRAY WRIST|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73110||PC STANDARD FEE SCHEDULE|116.00 PEMBINA COUNTY MEDICAL CENTER|3200056|XRAY HAND|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73120||PC STANDARD FEE SCHEDULE|81.00 PEMBINA COUNTY MEDICAL CENTER|3200057|XRAY HAND|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73130||PC STANDARD FEE SCHEDULE|96.00 PEMBINA COUNTY MEDICAL CENTER|3200058|XRAY FINGER|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73140||PC STANDARD FEE SCHEDULE|107.00 PEMBINA COUNTY MEDICAL CENTER|3200067|XRAY KNEE|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73560||PC STANDARD FEE SCHEDULE|89.00 PEMBINA COUNTY MEDICAL CENTER|3200068|XRAY KNEE|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73562||PC STANDARD FEE SCHEDULE|112.00 PEMBINA COUNTY MEDICAL CENTER|3200069|XRAY KNEE|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73564||PC STANDARD FEE SCHEDULE|129.00 PEMBINA COUNTY MEDICAL CENTER|3200070|XRAY KNEES-STANDING|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73565||PC STANDARD FEE SCHEDULE|105.00 PEMBINA COUNTY MEDICAL CENTER|3200072|XRAY LOWER LEG|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73590||PC STANDARD FEE SCHEDULE|79.00 PEMBINA COUNTY MEDICAL CENTER|3200074|HC CHILD LOWER EXT MIN 2 VIEWS|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73592||PC STANDARD FEE SCHEDULE|100.00 PEMBINA COUNTY MEDICAL CENTER|3200075|XRAY ANKLE|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73600||PC STANDARD FEE SCHEDULE|84.00 PEMBINA COUNTY MEDICAL CENTER|3200076|XRAY ANKLE|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73610||PC STANDARD FEE SCHEDULE|102.00 PEMBINA COUNTY MEDICAL CENTER|3200078|XRAY FOOT|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73620||PC STANDARD FEE SCHEDULE|81.00 PEMBINA COUNTY MEDICAL CENTER|3200079|XRAY FOOT|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73630||PC STANDARD FEE SCHEDULE|95.00 PEMBINA COUNTY MEDICAL CENTER|3200080|XRAY HEEL|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73650||PC STANDARD FEE SCHEDULE|83.00 PEMBINA COUNTY MEDICAL CENTER|3200081|XRAY TOE(S)|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73660||PC STANDARD FEE SCHEDULE|95.00 PEMBINA COUNTY MEDICAL CENTER|3200084|XRAY ABDOMEN|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|74022||PC STANDARD FEE SCHEDULE|133.00 PEMBINA COUNTY MEDICAL CENTER|3200092|HC SMALL BOWEL EXAM|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|74250||PC STANDARD FEE SCHEDULE|344.00 PEMBINA COUNTY MEDICAL CENTER|3200215|HC BONE SURVEY COMPLETE|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|77075||PC STANDARD FEE SCHEDULE|311.00 PEMBINA COUNTY MEDICAL CENTER|3200218|DEXASCAN|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|77080||PC STANDARD FEE SCHEDULE|221.00 PEMBINA COUNTY MEDICAL CENTER|3240007|XR-RIBS 2 VIEWS|RADIOLOGY - DIAGNOSTIC - CHEST X-RAY [0324]|71100||PC STANDARD FEE SCHEDULE|89.00 PEMBINA COUNTY MEDICAL CENTER|3240008|XR-RIBS 3+ VIEWS|RADIOLOGY - DIAGNOSTIC - CHEST X-RAY [0324]|71101||PC STANDARD FEE SCHEDULE|108.00 PEMBINA COUNTY MEDICAL CENTER|3240009|XR-RIBS 3 VIEWS|RADIOLOGY - DIAGNOSTIC - CHEST X-RAY [0324]|71110||PC STANDARD FEE SCHEDULE|112.00 PEMBINA COUNTY MEDICAL CENTER|3240010|XR-RIBS 4 VIEWS|RADIOLOGY - DIAGNOSTIC - CHEST X-RAY [0324]|71111||PC STANDARD FEE SCHEDULE|152.00 PEMBINA COUNTY MEDICAL CENTER|3240011|XR-STERNUM 2+ VIEWS|RADIOLOGY - DIAGNOSTIC - CHEST X-RAY [0324]|71120||PC STANDARD FEE SCHEDULE|89.00 PEMBINA COUNTY MEDICAL CENTER|3310000|CHEMO ADMINISTRATION|RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - INJECTED [0331]|96401||PC STANDARD FEE SCHEDULE|109.00 PEMBINA COUNTY MEDICAL CENTER|3350000|CHEMO ADMINISTRATION|RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - IV [0335]|96409||PC STANDARD FEE SCHEDULE|407.00 PEMBINA COUNTY MEDICAL CENTER|3350002|CHEMO ADMINISTRATION|RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - IV [0335]|96413||PC STANDARD FEE SCHEDULE|642.00 PEMBINA COUNTY MEDICAL CENTER|3350003|CHEMO ADMINISTRATION|RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - IV [0335]|96415||PC STANDARD FEE SCHEDULE|109.00 PEMBINA COUNTY MEDICAL CENTER|3350004|HC CHEMO INFUSION UP TO 1 HR|RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - IV [0335]|96422||PC STANDARD FEE SCHEDULE|642.00 PEMBINA COUNTY MEDICAL CENTER|3410011|LIVER SPECT|NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES [0341]|78205||PC STANDARD FEE SCHEDULE|895.00 PEMBINA COUNTY MEDICAL CENTER|3410013|NM LIVER SPLEEN SCAN|NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES [0341]|78215||PC STANDARD FEE SCHEDULE|693.00 PEMBINA COUNTY MEDICAL CENTER|3410017|HC GASTRO-REFLUX SCAN|NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES [0341]|78262||PC STANDARD FEE SCHEDULE|889.00 PEMBINA COUNTY MEDICAL CENTER|3410024|NM MECKELS|NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES [0341]|78290||PC STANDARD FEE SCHEDULE|1,191.00 PEMBINA COUNTY MEDICAL CENTER|3410025|BONE LIMITED|NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES [0341]|78300||PC STANDARD FEE SCHEDULE|597.00 PEMBINA COUNTY MEDICAL CENTER|3410026|NM BONE SCAN|NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES [0341]|78305||PC STANDARD FEE SCHEDULE|795.00 PEMBINA COUNTY MEDICAL CENTER|3410027|BONE SCAN|NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES [0341]|78306||PC STANDARD FEE SCHEDULE|892.00 PEMBINA COUNTY MEDICAL CENTER|3410028|BONE SCAN|NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES [0341]|78315||PC STANDARD FEE SCHEDULE|1,212.00 PEMBINA COUNTY MEDICAL CENTER|3410029|NM BONE SCAN|NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES [0341]|78320||PC STANDARD FEE SCHEDULE|895.00 PEMBINA COUNTY MEDICAL CENTER|3410039|CARDIAC BLOOD POOL (MUGA)|NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES [0341]|78472||PC STANDARD FEE SCHEDULE|943.00 PEMBINA COUNTY MEDICAL CENTER|3410060|HC RENAL SPECT|NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES [0341]|78710||PC STANDARD FEE SCHEDULE|879.00 PEMBINA COUNTY MEDICAL CENTER|3430001|NM CARDIOLITE PER SYRINGE|NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS [0343]|A9500||PC STANDARD FEE SCHEDULE|203.00 PEMBINA COUNTY MEDICAL CENTER|3430003|HC MDP PER DOSE|NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS [0343]|A9503||PC STANDARD FEE SCHEDULE|65.00 PEMBINA COUNTY MEDICAL CENTER|3430008|HC TC04 PER DOSE|NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS [0343]|A9512||PC STANDARD FEE SCHEDULE|19.00 PEMBINA COUNTY MEDICAL CENTER|3430011|HC CHOLETEC PER DOSE|NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS [0343]|A9537||PC STANDARD FEE SCHEDULE|149.00 PEMBINA COUNTY MEDICAL CENTER|3430026|HC MAG-3 PER DOSE|NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS [0343]|A9562||PC STANDARD FEE SCHEDULE|216.00 PEMBINA COUNTY MEDICAL CENTER|3500000|CT-NECK|CT SCAN - GENERAL CLASSIFICATION [0350]|70490||PC STANDARD FEE SCHEDULE|853.00 PEMBINA COUNTY MEDICAL CENTER|3500001|CT-NECK|CT SCAN - GENERAL CLASSIFICATION [0350]|70491||PC STANDARD FEE SCHEDULE|1,057.00 PEMBINA COUNTY MEDICAL CENTER|3500002|CT-NECK|CT SCAN - GENERAL CLASSIFICATION [0350]|70492||PC STANDARD FEE SCHEDULE|1,330.00 PEMBINA COUNTY MEDICAL CENTER|3500004|HC CTA NECK|CT SCAN - GENERAL CLASSIFICATION [0350]|70498||PC STANDARD FEE SCHEDULE|2,242.00 PEMBINA COUNTY MEDICAL CENTER|3500005|CT-CHEST|CT SCAN - GENERAL CLASSIFICATION [0350]|71275||PC STANDARD FEE SCHEDULE|1,094.00 PEMBINA COUNTY MEDICAL CENTER|3500008|CT-THORACIC SPINE|CT SCAN - GENERAL CLASSIFICATION [0350]|72128||PC STANDARD FEE SCHEDULE|1,364.00 PEMBINA COUNTY MEDICAL CENTER|3500011|CT-LUMBAR SPINE|CT SCAN - GENERAL CLASSIFICATION [0350]|72131||PC STANDARD FEE SCHEDULE|876.00 PEMBINA COUNTY MEDICAL CENTER|3500016|CT UPPER EXTREMITY|CT SCAN - GENERAL CLASSIFICATION [0350]|73200||PC STANDARD FEE SCHEDULE|857.00 PEMBINA COUNTY MEDICAL CENTER|3500017|CT UPPER EXTREMITY|CT SCAN - GENERAL CLASSIFICATION [0350]|73201||PC STANDARD FEE SCHEDULE|1,061.00 PEMBINA COUNTY MEDICAL CENTER|3500019|HC CTA UPPER EXTREMITY|CT SCAN - GENERAL CLASSIFICATION [0350]|73206||PC STANDARD FEE SCHEDULE|1,499.00 PEMBINA COUNTY MEDICAL CENTER|3500020|CT LOWER EXTREMITY|CT SCAN - GENERAL CLASSIFICATION [0350]|73700||PC STANDARD FEE SCHEDULE|861.00 PEMBINA COUNTY MEDICAL CENTER|3500021|CT LOWER EXTREMITY|CT SCAN - GENERAL CLASSIFICATION [0350]|73701||PC STANDARD FEE SCHEDULE|1,070.00 PEMBINA COUNTY MEDICAL CENTER|3500022|CT LOWER EXTREMITY|CT SCAN - GENERAL CLASSIFICATION [0350]|73702||PC STANDARD FEE SCHEDULE|1,416.00 PEMBINA COUNTY MEDICAL CENTER|3500027|CT STEALTH SCAN|CT SCAN - GENERAL CLASSIFICATION [0350]|76380||PC STANDARD FEE SCHEDULE|621.00 PEMBINA COUNTY MEDICAL CENTER|3500028|HC CT BIOPSY/CYST ASPIR|CT SCAN - GENERAL CLASSIFICATION [0350]|77012||PC STANDARD FEE SCHEDULE|432.00 PEMBINA COUNTY MEDICAL CENTER|3510000|CT-BRAIN|CT SCAN - HEAD SCAN [0351]|70450||PC STANDARD FEE SCHEDULE|676.00 PEMBINA COUNTY MEDICAL CENTER|3510001|CT-BRAIN|CT SCAN - HEAD SCAN [0351]|70460||PC STANDARD FEE SCHEDULE|877.00 PEMBINA COUNTY MEDICAL CENTER|3510002|CT-BRAIN|CT SCAN - HEAD SCAN [0351]|70470||PC STANDARD FEE SCHEDULE|921.00 PEMBINA COUNTY MEDICAL CENTER|3510003|CT-EAR|CT SCAN - HEAD SCAN [0351]|70480||PC STANDARD FEE SCHEDULE|1,068.00 PEMBINA COUNTY MEDICAL CENTER|3510004|CT EAR|CT SCAN - HEAD SCAN [0351]|70481||PC STANDARD FEE SCHEDULE|1,264.00 PEMBINA COUNTY MEDICAL CENTER|3510005|CT-EAR|CT SCAN - HEAD SCAN [0351]|70482||PC STANDARD FEE SCHEDULE|1,476.00 PEMBINA COUNTY MEDICAL CENTER|3510006|CT-FACIAL BONE|CT SCAN - HEAD SCAN [0351]|70486||PC STANDARD FEE SCHEDULE|892.00 PEMBINA COUNTY MEDICAL CENTER|3510007|CT-FACIAL BONES|CT SCAN - HEAD SCAN [0351]|70487||PC STANDARD FEE SCHEDULE|1,095.00 PEMBINA COUNTY MEDICAL CENTER|3520000|CT-THORAX|CT SCAN - BODY SCAN [0352]|71250||PC STANDARD FEE SCHEDULE|874.00 PEMBINA COUNTY MEDICAL CENTER|3520002|CT THORAX|CT SCAN - BODY SCAN [0352]|71270||PC STANDARD FEE SCHEDULE|1,370.00 PEMBINA COUNTY MEDICAL CENTER|3520003|CT-CERVICAL SPINE|CT SCAN - BODY SCAN [0352]|72125||PC STANDARD FEE SCHEDULE|882.00 PEMBINA COUNTY MEDICAL CENTER|3520004|CT PELVIS|CT SCAN - BODY SCAN [0352]|72192||PC STANDARD FEE SCHEDULE|823.00 PEMBINA COUNTY MEDICAL CENTER|3520005|CT PELVIS|CT SCAN - BODY SCAN [0352]|72193||PC STANDARD FEE SCHEDULE|1,036.00 PEMBINA COUNTY MEDICAL CENTER|3520006|CT PELVIS|CT SCAN - BODY SCAN [0352]|72194||PC STANDARD FEE SCHEDULE|1,392.00 PEMBINA COUNTY MEDICAL CENTER|3520007|CT ABDOMEN|CT SCAN - BODY SCAN [0352]|74150||PC STANDARD FEE SCHEDULE|818.00 PEMBINA COUNTY MEDICAL CENTER|3520008|CT ABDOMEN|CT SCAN - BODY SCAN [0352]|74160||PC STANDARD FEE SCHEDULE|1,197.00 PEMBINA COUNTY MEDICAL CENTER|3520009|CT ABDOMEN|CT SCAN - BODY SCAN [0352]|74170||PC STANDARD FEE SCHEDULE|1,620.00 PEMBINA COUNTY MEDICAL CENTER|3520010|CT-THORAX|CT SCAN - BODY SCAN [0352]|71260||PC STANDARD FEE SCHEDULE|1,094.00 PEMBINA COUNTY MEDICAL CENTER|3600000|HC INJ TRIGGER POINT,3 OR MORE|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|20553||PC STANDARD FEE SCHEDULE|422.00 PEMBINA COUNTY MEDICAL CENTER|3910000|HC BLOOD ADMIN 2+ HRS|ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - ADMINISTRATION (E.G., TRANS [0391]|36430||PC STANDARD FEE SCHEDULE|504.00 PEMBINA COUNTY MEDICAL CENTER|4020000|HC ECHO EXAM OF HEAD|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76506||PC STANDARD FEE SCHEDULE|375.00 PEMBINA COUNTY MEDICAL CENTER|4020004|US EXAM HEAD/NECK|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76536||PC STANDARD FEE SCHEDULE|377.00 PEMBINA COUNTY MEDICAL CENTER|4020007|US EXAM ABDOMEN COMPLETE|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76700||PC STANDARD FEE SCHEDULE|423.00 PEMBINA COUNTY MEDICAL CENTER|4020008|US EXAM ABDOMEN LMTD|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76705||PC STANDARD FEE SCHEDULE|324.00 PEMBINA COUNTY MEDICAL CENTER|4020009|US RENAL COMPLETE|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76770||PC STANDARD FEE SCHEDULE|412.00 PEMBINA COUNTY MEDICAL CENTER|4020010|US RENAL LMTD|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76775||PC STANDARD FEE SCHEDULE|359.00 PEMBINA COUNTY MEDICAL CENTER|4020013|US OB COMPLETE(<14 WKS)|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76801||PC STANDARD FEE SCHEDULE|368.00 PEMBINA COUNTY MEDICAL CENTER|4020014|HC MULTIPLE GESTATION(<14 WKS)|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76802||PC STANDARD FEE SCHEDULE|137.00 PEMBINA COUNTY MEDICAL CENTER|4020015|US PREGNANCY COMPLETE|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76805||PC STANDARD FEE SCHEDULE|432.00 PEMBINA COUNTY MEDICAL CENTER|4020016|US PREGNANCY CMPLT ADDL FETUS|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76810||PC STANDARD FEE SCHEDULE|240.00 PEMBINA COUNTY MEDICAL CENTER|4020017|US PREGNANCY LMTD|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76815||PC STANDARD FEE SCHEDULE|289.00 PEMBINA COUNTY MEDICAL CENTER|4020018|HC FOLLOW UP/REPEAT OB|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76816||PC STANDARD FEE SCHEDULE|312.00 PEMBINA COUNTY MEDICAL CENTER|4020020|HC BIO PROFILE|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76819||PC STANDARD FEE SCHEDULE|260.00 PEMBINA COUNTY MEDICAL CENTER|4020022|US TRANSVAGINAL|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76830||PC STANDARD FEE SCHEDULE|377.00 PEMBINA COUNTY MEDICAL CENTER|4020024|US PELVIC COMPLETE|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76856||PC STANDARD FEE SCHEDULE|378.00 PEMBINA COUNTY MEDICAL CENTER|4020025|US PELVIC LIMITED|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76857||PC STANDARD FEE SCHEDULE|331.00 PEMBINA COUNTY MEDICAL CENTER|4020026|US SCROTUM|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76870||PC STANDARD FEE SCHEDULE|384.00 PEMBINA COUNTY MEDICAL CENTER|4020029|HC US EXTREMITY|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76880||PC STANDARD FEE SCHEDULE|384.00 PEMBINA COUNTY MEDICAL CENTER|4020031|HC ECHO GUIDE CARDIOCENTESIS|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76930||PC STANDARD FEE SCHEDULE|260.00 PEMBINA COUNTY MEDICAL CENTER|4020033|HC US GUIDANCE VASCULAR ACCESS|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76937||PC STANDARD FEE SCHEDULE|93.00 PEMBINA COUNTY MEDICAL CENTER|4020035|HC US GUIDANCE/BX|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76942||PC STANDARD FEE SCHEDULE|682.00 PEMBINA COUNTY MEDICAL CENTER|4020036|HC AMNIOCENTESIS GUIDANCE|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76946||PC STANDARD FEE SCHEDULE|80.00 PEMBINA COUNTY MEDICAL CENTER|4020039|HC INTEROPERATIVE U/S|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76998||PC STANDARD FEE SCHEDULE|392.00 PEMBINA COUNTY MEDICAL CENTER|4200004|TRACTION|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|97012||PC STANDARD FEE SCHEDULE|50.00 PEMBINA COUNTY MEDICAL CENTER|4200005|UNATTEND E-STIM|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|97014||PC STANDARD FEE SCHEDULE|49.00 PEMBINA COUNTY MEDICAL CENTER|4200009|GAIT TRAINING|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|97116||PC STANDARD FEE SCHEDULE|86.00 PEMBINA COUNTY MEDICAL CENTER|4200010|MASSAGE|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|97124||PC STANDARD FEE SCHEDULE|80.00 PEMBINA COUNTY MEDICAL CENTER|4200011|PHYSICAL PERFORMANCE TEST|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|97750||PC STANDARD FEE SCHEDULE|103.00 PEMBINA COUNTY MEDICAL CENTER|4200012|ORTHO MGT/TRAINING INITIAL|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|97760||PC STANDARD FEE SCHEDULE|115.00 PEMBINA COUNTY MEDICAL CENTER|4200013|PROSTHETIC TRAINING 15 MIN|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|97761||PC STANDARD FEE SCHEDULE|102.00 PEMBINA COUNTY MEDICAL CENTER|4300000|TENS|OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION [0430]|64550||PC STANDARD FEE SCHEDULE|23.00 PEMBINA COUNTY MEDICAL CENTER|4300001|VASOPNEUMATIC DEVICE|OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION [0430]|97016||PC STANDARD FEE SCHEDULE|59.00 PEMBINA COUNTY MEDICAL CENTER|4300002|PARAFFIN BATH|OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION [0430]|97018||PC STANDARD FEE SCHEDULE|34.00 PEMBINA COUNTY MEDICAL CENTER|4300003|WHIRLPOOL|OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION [0430]|97022||PC STANDARD FEE SCHEDULE|70.00 PEMBINA COUNTY MEDICAL CENTER|4300004|HC INFRARED|OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION [0430]|97026||PC STANDARD FEE SCHEDULE|19.00 PEMBINA COUNTY MEDICAL CENTER|4300005|E-STIM 15 MIN|OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION [0430]|97032||PC STANDARD FEE SCHEDULE|59.00 PEMBINA COUNTY MEDICAL CENTER|4300006|IONTOPHORESIS 15 MIN|OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION [0430]|97033||PC STANDARD FEE SCHEDULE|96.00 PEMBINA COUNTY MEDICAL CENTER|4300007|CONTRAST BATH 15 MIN|OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION [0430]|97034||PC STANDARD FEE SCHEDULE|54.00 PEMBINA COUNTY MEDICAL CENTER|4300008|ULTRASOUND 15 MIN|OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION [0430]|97035||PC STANDARD FEE SCHEDULE|39.00 PEMBINA COUNTY MEDICAL CENTER|4300010|THERAP EXERCISE 15MIN|OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION [0430]|97110||PC STANDARD FEE SCHEDULE|96.00 PEMBINA COUNTY MEDICAL CENTER|4300011|NEUROMUSC RE-ED 15MIN|OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION [0430]|97112||PC STANDARD FEE SCHEDULE|102.00 PEMBINA COUNTY MEDICAL CENTER|4300013|MANUAL THERAPY 15MIN|OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION [0430]|97140||PC STANDARD FEE SCHEDULE|91.00 PEMBINA COUNTY MEDICAL CENTER|4300014|THERAPEUTIC GROUP 15 MIN|OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION [0430]|97150||PC STANDARD FEE SCHEDULE|62.00 PEMBINA COUNTY MEDICAL CENTER|4300015|THERAPY ACTIVITY 15MIN|OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION [0430]|97530||PC STANDARD FEE SCHEDULE|107.00 PEMBINA COUNTY MEDICAL CENTER|4300018|SELF-CARE/HM MGMT TX 15MIN|OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION [0430]|97535||PC STANDARD FEE SCHEDULE|105.00 PEMBINA COUNTY MEDICAL CENTER|4300019|COM/WORK RE-INTEGRA 15 MIN|OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION [0430]|97537||PC STANDARD FEE SCHEDULE|91.00 PEMBINA COUNTY MEDICAL CENTER|4300020|WHEELCHAIR MGMT/PROP 15 MIN|OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION [0430]|97542||PC STANDARD FEE SCHEDULE|93.00 PEMBINA COUNTY MEDICAL CENTER|4300023|DEBRIDEMENT|OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION [0430]|97597||PC STANDARD FEE SCHEDULE|238.00 PEMBINA COUNTY MEDICAL CENTER|4300029|HC E-STIM-UNATTENDED|OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION [0430]|G0283||PC STANDARD FEE SCHEDULE|49.00 PEMBINA COUNTY MEDICAL CENTER|4400001|SPEECH/HEARING THERAPY|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|92507||PC STANDARD FEE SCHEDULE|237.00 PEMBINA COUNTY MEDICAL CENTER|4400003|DYSPHAGIA STUDY|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|92526||PC STANDARD FEE SCHEDULE|262.00 PEMBINA COUNTY MEDICAL CENTER|4400007|SWALLOWING EVAL|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|92610||PC STANDARD FEE SCHEDULE|283.00 PEMBINA COUNTY MEDICAL CENTER|4400008|HC SWAL VIDEO|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|92611||PC STANDARD FEE SCHEDULE|309.00 PEMBINA COUNTY MEDICAL CENTER|4500002|HC REPR SUPERF WND BODY 12.6-20|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|12005||PC STANDARD FEE SCHEDULE|202.00 PEMBINA COUNTY MEDICAL CENTER|4500013|HC CLOSED RX CLAVICLE FRACTURE|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|23500||PC STANDARD FEE SCHEDULE|312.00 PEMBINA COUNTY MEDICAL CENTER|4500025|HC CLOSED RX RAD/ULNA SHAFT FX|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|25560||PC STANDARD FEE SCHEDULE|312.00 PEMBINA COUNTY MEDICAL CENTER|4500036|HC TREAT KNEE DISLOCATION|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|27550||PC STANDARD FEE SCHEDULE|299.00 PEMBINA COUNTY MEDICAL CENTER|4500043|HC APPLY FOREARM CAST|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|29075||PC STANDARD FEE SCHEDULE|446.00 PEMBINA COUNTY MEDICAL CENTER|4500045|HC APPLY LONG ARM SPLINT|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|29105||PC STANDARD FEE SCHEDULE|222.00 PEMBINA COUNTY MEDICAL CENTER|4500046|HC APPLY FOREARM SPLINT,STATIC|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|29125||PC STANDARD FEE SCHEDULE|222.00 PEMBINA COUNTY MEDICAL CENTER|4500052|APPLY SHORT LEG CAST|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|29405||PC STANDARD FEE SCHEDULE|446.00 PEMBINA COUNTY MEDICAL CENTER|4500061|HC CONTROL NOSE BLEED,INITIAL|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|30905||PC STANDARD FEE SCHEDULE|182.00 PEMBINA COUNTY MEDICAL CENTER|4500062|HC CONTROL NOSE BLEED,SUBSEQUENT|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|30906||PC STANDARD FEE SCHEDULE|182.00 PEMBINA COUNTY MEDICAL CENTER|4500086|HC REMOVE FB FROM EYE CORNEA SLIT LAMP|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|65222||PC STANDARD FEE SCHEDULE|175.00 PEMBINA COUNTY MEDICAL CENTER|4500087|HC IRIDOTOMY/IRIDECTOMY BY LASER|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|66761||PC STANDARD FEE SCHEDULE|960.00 PEMBINA COUNTY MEDICAL CENTER|4500096|ED LEVEL I|EMERGENCY ROOM - GENERAL CLASSIFICATION [0450]|99281||PC STANDARD FEE SCHEDULE|179.00 PEMBINA COUNTY MEDICAL CENTER|4500097|ED LEVEL II|EMERGENCY ROOM - GENERAL CLASSIFICATION [0450]|99282||PC STANDARD FEE SCHEDULE|244.00 PEMBINA COUNTY MEDICAL CENTER|4500098|ED LEVEL III|EMERGENCY ROOM - GENERAL CLASSIFICATION [0450]|99283||PC STANDARD FEE SCHEDULE|363.00 PEMBINA COUNTY MEDICAL CENTER|4500099|ED LEVEL IV|EMERGENCY ROOM - GENERAL CLASSIFICATION [0450]|99284||PC STANDARD FEE SCHEDULE|645.00 PEMBINA COUNTY MEDICAL CENTER|4500100|ED LEVEL V|EMERGENCY ROOM - GENERAL CLASSIFICATION [0450]|99285||PC STANDARD FEE SCHEDULE|1,123.00 PEMBINA COUNTY MEDICAL CENTER|4500101|CRITICAL CARE 1ST HOUR|EMERGENCY ROOM - GENERAL CLASSIFICATION [0450]|99291||PC STANDARD FEE SCHEDULE|1,511.00 PEMBINA COUNTY MEDICAL CENTER|4560004|URGENT CARE VISIT-EST PT LEVEL I|URGENT CARE [0456]|99211||PC STANDARD FEE SCHEDULE|35.00 PEMBINA COUNTY MEDICAL CENTER|4800009|HC TTE W/DOPPLER COMPLETE|CARDIOLOGY - ECHOCARDIOLOGY [0483]|93306||PC STANDARD FEE SCHEDULE|467.00 PEMBINA COUNTY MEDICAL CENTER|4800011|ECHO EXAM LIMITED|CARDIOLOGY - ECHOCARDIOLOGY [0483]|93308||PC STANDARD FEE SCHEDULE|240.00 PEMBINA COUNTY MEDICAL CENTER|4820000|STRESS TEST|CARDIOLOGY - STRESS TEST [0482]|93017||PC STANDARD FEE SCHEDULE|242.00 PEMBINA COUNTY MEDICAL CENTER|4900044|HC EXC SKIN BENIG 1.1-2CM TRUNK,ARM,LEG|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|11402||PC STANDARD FEE SCHEDULE|791.00 PEMBINA COUNTY MEDICAL CENTER|4900078|HC EXC SKIN MALIG 0.6-1CM FACE,FACIAL|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|11641||PC STANDARD FEE SCHEDULE|791.00 PEMBINA COUNTY MEDICAL CENTER|4900080|HC EXC SKIN MALIG 2.1-3CM FACE,FACIAL|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|11643||PC STANDARD FEE SCHEDULE|1,317.00 PEMBINA COUNTY MEDICAL CENTER|4900107|HC REMOVE CONTRACEPTIVE CAP|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|11976||PC STANDARD FEE SCHEDULE|756.00 PEMBINA COUNTY MEDICAL CENTER|4900110|HC REPR SUPERF WND BODY <2.5CM|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|12001||PC STANDARD FEE SCHEDULE|202.00 PEMBINA COUNTY MEDICAL CENTER|4900111|HC REPR SUP NPTERF WND BODY 2.6-7.5|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|12002||PC STANDARD FEE SCHEDULE|202.00 PEMBINA COUNTY MEDICAL CENTER|4900112|HC REPR SUPERF WND BODY 7.6-12.5|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|12004||PC STANDARD FEE SCHEDULE|202.00 PEMBINA COUNTY MEDICAL CENTER|4900114|HC REPR SUPERF WND FACE <2.5CM|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|12011||PC STANDARD FEE SCHEDULE|202.00 PEMBINA COUNTY MEDICAL CENTER|4900115|HC REPR SUPERF WND FACE 2.6-5|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|12013||PC STANDARD FEE SCHEDULE|202.00 PEMBINA COUNTY MEDICAL CENTER|4900120|HC LAYR CLOS WND TRUNK,ARM,LEG <2.5CM|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|12031||PC STANDARD FEE SCHEDULE|591.00 PEMBINA COUNTY MEDICAL CENTER|4900121|HC LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|12032||PC STANDARD FEE SCHEDULE|591.00 PEMBINA COUNTY MEDICAL CENTER|4900122|HC LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.5|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|12034||PC STANDARD FEE SCHEDULE|591.00 PEMBINA COUNTY MEDICAL CENTER|4900123|HC LAYR CLOS WND TRUNK,ARM,LEG 12.6-20|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|12035||PC STANDARD FEE SCHEDULE|591.00 PEMBINA COUNTY MEDICAL CENTER|4900127|HC LAYR CLOS WND REST BODY 2.6-7.5|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|12042||PC STANDARD FEE SCHEDULE|591.00 PEMBINA COUNTY MEDICAL CENTER|4900132|HC LAYR CLOS WND FACIAL<2.5CM|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|12051||PC STANDARD FEE SCHEDULE|591.00 PEMBINA COUNTY MEDICAL CENTER|4900133|HC LAYR CLOS WND FACE,FACIAL 2.5-5|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|12052||PC STANDARD FEE SCHEDULE|591.00 PEMBINA COUNTY MEDICAL CENTER|4900134|HC LAYR CLOS WND FACE,FACIAL 5.1-7.5|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|12053||PC STANDARD FEE SCHEDULE|591.00 PEMBINA COUNTY MEDICAL CENTER|4900192|HC MUSCLE-SKIN GRAFT, TRUNK|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|15734||PC STANDARD FEE SCHEDULE|3,396.00 PEMBINA COUNTY MEDICAL CENTER|4900216|HC EXCISE EXCESS SKIN TISSUE,ARM|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|15836||PC STANDARD FEE SCHEDULE|8,187.00 PEMBINA COUNTY MEDICAL CENTER|4900242|HC DESTRUCT BENIGN LESION, 1-14|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|17110||PC STANDARD FEE SCHEDULE|170.00 PEMBINA COUNTY MEDICAL CENTER|4900322|HC RAD INJECT/ASPIR JNTMAJOR|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|20610||PC STANDARD FEE SCHEDULE|432.00 PEMBINA COUNTY MEDICAL CENTER|4900461|HC CLOSED RX SHLDR DISLOCATION|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|23650||PC STANDARD FEE SCHEDULE|312.00 PEMBINA COUNTY MEDICAL CENTER|4900514|HC CLOSED RX RADIAL HEAD/NECK FX|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|24650||PC STANDARD FEE SCHEDULE|299.00 PEMBINA COUNTY MEDICAL CENTER|4900847|HC CLOSED RX WEIGHT BEAR DIST TIBIA|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|27824||PC STANDARD FEE SCHEDULE|312.00 PEMBINA COUNTY MEDICAL CENTER|4900874|HC PARTIAL REMOVAL,FOOT FASCIA|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|28060||PC STANDARD FEE SCHEDULE|2,945.00 PEMBINA COUNTY MEDICAL CENTER|4900899|HC REMV FOOT FOREIGN BODY,SUBCUTANEOUS|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|28190||PC STANDARD FEE SCHEDULE|1,376.00 PEMBINA COUNTY MEDICAL CENTER|4901080|HC CONTROL NOSE BLEED,SMPL|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|30901||PC STANDARD FEE SCHEDULE|182.00 PEMBINA COUNTY MEDICAL CENTER|4901081|HC CONTROL NOSE BLEED,CMPLX|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|30903||PC STANDARD FEE SCHEDULE|182.00 PEMBINA COUNTY MEDICAL CENTER|4902031|HC LAPAROSCOPY,FUNDOPLASTY|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|43280||PC STANDARD FEE SCHEDULE|18,542.00 PEMBINA COUNTY MEDICAL CENTER|4902063|HC BIOPSY TONGUE,ANTER 2/3|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|41100||PC STANDARD FEE SCHEDULE|1,069.00 PEMBINA COUNTY MEDICAL CENTER|4902106|HC LAPAROSCOPY/APPENDECTOMY|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|44970||PC STANDARD FEE SCHEDULE|7,835.00 PEMBINA COUNTY MEDICAL CENTER|4902146|HC LIGATION OF HEMORRHOID(S)|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|46221||PC STANDARD FEE SCHEDULE|1,011.00 PEMBINA COUNTY MEDICAL CENTER|4902216|HC LAPAROSCOPIC CHOLECYSTECTOMY|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|47562||PC STANDARD FEE SCHEDULE|7,835.00 PEMBINA COUNTY MEDICAL CENTER|4901266|HC COLLECT BLOOD VENOUS DEVICE|LABORATORY - GENERAL CLASSIFICATION [0300]|36591||PC STANDARD FEE SCHEDULE|96.00 PEMBINA COUNTY MEDICAL CENTER|4901267|HC COLLECT BLOOD PICC|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|36592||PC STANDARD FEE SCHEDULE|96.00 PEMBINA COUNTY MEDICAL CENTER|4902270|HC RPR HERNIA,REDUC|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|49560||PC STANDARD FEE SCHEDULE|5,690.00 PEMBINA COUNTY MEDICAL CENTER|4902274|HC RPR HERNIA W/MESH|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|49568||PC STANDARD FEE SCHEDULE|5,690.00 PEMBINA COUNTY MEDICAL CENTER|4902280|HC REPAIR SPIGILIAN HERNIA|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|49590||PC STANDARD FEE SCHEDULE|5,185.00 PEMBINA COUNTY MEDICAL CENTER|4902281|HC LAPARO HERNIA REPAIR INITIAL|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|49650||PC STANDARD FEE SCHEDULE|7,835.00 PEMBINA COUNTY MEDICAL CENTER|4901354|TREAT BLADDER LESION|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|51720||PC STANDARD FEE SCHEDULE|538.00 PEMBINA COUNTY MEDICAL CENTER|4901674|HC PLANTAR NERVE BLOCK|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|64455||PC STANDARD FEE SCHEDULE|342.00 PEMBINA COUNTY MEDICAL CENTER|4901737|REMOVE FB-EYE|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|65220||PC STANDARD FEE SCHEDULE|175.00 PEMBINA COUNTY MEDICAL CENTER|4901775|YAG LASER|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|66821||PC STANDARD FEE SCHEDULE|960.00 PEMBINA COUNTY MEDICAL CENTER|4901948|COLONOSCOPY|AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION [0490]|G0105||PC STANDARD FEE SCHEDULE|1,435.00 PEMBINA COUNTY MEDICAL CENTER|4901949|COLONSCOPY|AMBULATORY SURGICAL CARE - GENERAL CLASSIFICATION [0490]|G0121||PC STANDARD FEE SCHEDULE|1,435.00 PEMBINA COUNTY MEDICAL CENTER|5100022|HC ALLERGEN IMMUN;SINGLE INJECTIO|CLINIC - GENERAL CLASSIFICATION [0510]|95115||PC STANDARD FEE SCHEDULE|32.00 PEMBINA COUNTY MEDICAL CENTER|5100023|HC ALLERGEN IMMUN;2 OR MORE INJEC|CLINIC - GENERAL CLASSIFICATION [0510]|95117||PC STANDARD FEE SCHEDULE|38.00 PEMBINA COUNTY MEDICAL CENTER|6100000|MRI-EYE/FACE/NECK|MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION [0610]|70540||PC STANDARD FEE SCHEDULE|1,875.00 PEMBINA COUNTY MEDICAL CENTER|6100002|MRI EYE/FACE/NECK|MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION [0610]|70543||PC STANDARD FEE SCHEDULE|2,615.00 PEMBINA COUNTY MEDICAL CENTER|6100003|MRA-HEAD|MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION [0610]|70544||PC STANDARD FEE SCHEDULE|2,140.00 PEMBINA COUNTY MEDICAL CENTER|6100007|HC MRA NECK W/DYE|MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION [0610]|70548||PC STANDARD FEE SCHEDULE|2,233.00 PEMBINA COUNTY MEDICAL CENTER|6100008|MRA-NECK|MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION [0610]|70549||PC STANDARD FEE SCHEDULE|3,331.00 PEMBINA COUNTY MEDICAL CENTER|6100009|MRI-CHEST|MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION [0610]|71550||PC STANDARD FEE SCHEDULE|2,165.00 PEMBINA COUNTY MEDICAL CENTER|6100013|PELVIS|MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION [0610]|72195||PC STANDARD FEE SCHEDULE|1,928.00 PEMBINA COUNTY MEDICAL CENTER|6100014|MRI-PELVIS|MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION [0610]|72196||PC STANDARD FEE SCHEDULE|2,118.00 PEMBINA COUNTY MEDICAL CENTER|6100015|MRI PELVIS|MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION [0610]|72197||PC STANDARD FEE SCHEDULE|2,656.00 PEMBINA COUNTY MEDICAL CENTER|6100017|UPPER EXT W/O DYE|MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION [0610]|73218||PC STANDARD FEE SCHEDULE|1,939.00 PEMBINA COUNTY MEDICAL CENTER|6100019|MRI-UPPER EXTREMITY|MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION [0610]|73220||PC STANDARD FEE SCHEDULE|2,545.00 PEMBINA COUNTY MEDICAL CENTER|6100020|MRI-UPPER EXTREMITY|MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION [0610]|73221||PC STANDARD FEE SCHEDULE|1,826.00 PEMBINA COUNTY MEDICAL CENTER|6100024|MRI LOWER EXTREMITY|MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION [0610]|73718||PC STANDARD FEE SCHEDULE|1,908.00 PEMBINA COUNTY MEDICAL CENTER|6100027|MRI LOWER EXTREMITY|MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION [0610]|73721||PC STANDARD FEE SCHEDULE|1,873.00 PEMBINA COUNTY MEDICAL CENTER|6100030|HC MRA LOWER EXT W/WO DYE|MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION [0610]|73725||PC STANDARD FEE SCHEDULE|2,042.00 PEMBINA COUNTY MEDICAL CENTER|6100031|MRI-ABDOMEN|MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION [0610]|74181||PC STANDARD FEE SCHEDULE|1,682.00 PEMBINA COUNTY MEDICAL CENTER|6100032|MRI ABDOMEN|MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION [0610]|74182||PC STANDARD FEE SCHEDULE|2,351.00 PEMBINA COUNTY MEDICAL CENTER|6100033|MRI ABDOMEN|MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION [0610]|74183||PC STANDARD FEE SCHEDULE|2,662.00 PEMBINA COUNTY MEDICAL CENTER|6100034|MRA ABDOMEN|MAGNETIC RESONANCE TECHNOLOGY (MRT) - GENERAL CLASSIFICATION [0610]|74185||PC STANDARD FEE SCHEDULE|2,036.00 PEMBINA COUNTY MEDICAL CENTER|6110000|MRI-TMJ|MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - BRAIN/BRAINSTEM [0611]|70336||PC STANDARD FEE SCHEDULE|1,615.00 PEMBINA COUNTY MEDICAL CENTER|6110001|MRI-BRAIN/BRAIN STEM|MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - BRAIN/BRAINSTEM [0611]|70551||PC STANDARD FEE SCHEDULE|1,942.00 PEMBINA COUNTY MEDICAL CENTER|6110002|MRI-BRAIN|MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - BRAIN/BRAINSTEM [0611]|70552||PC STANDARD FEE SCHEDULE|2,138.00 PEMBINA COUNTY MEDICAL CENTER|6110003|MRI-BRAIN|MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - BRAIN/BRAINSTEM [0611]|70553||PC STANDARD FEE SCHEDULE|2,555.00 PEMBINA COUNTY MEDICAL CENTER|6120000|MRI-C-SPINE|MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE) [0612]|72141||PC STANDARD FEE SCHEDULE|1,675.00 PEMBINA COUNTY MEDICAL CENTER|6120001|MRI-C-SPINE|MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE) [0612]|72142||PC STANDARD FEE SCHEDULE|2,146.00 PEMBINA COUNTY MEDICAL CENTER|6120002|MRI-T-SPINE|MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE) [0612]|72146||PC STANDARD FEE SCHEDULE|1,690.00 PEMBINA COUNTY MEDICAL CENTER|6120004|MRI-L-SPINE|MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE) [0612]|72148||PC STANDARD FEE SCHEDULE|1,689.00 PEMBINA COUNTY MEDICAL CENTER|6120005|MRI-LUMBAR SPINE|MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE) [0612]|72149||PC STANDARD FEE SCHEDULE|2,114.00 PEMBINA COUNTY MEDICAL CENTER|6120006|MRI-C-SPINE|MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE) [0612]|72156||PC STANDARD FEE SCHEDULE|2,501.00 PEMBINA COUNTY MEDICAL CENTER|6120007|T-SPINE|MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE) [0612]|72157||PC STANDARD FEE SCHEDULE|2,306.00 PEMBINA COUNTY MEDICAL CENTER|6120008|L-SPINE|MAGNETIC RESONANCE TECHNOLOGY (MRT) - MRI - SPINAL CORD/SPINE) [0612]|72158||PC STANDARD FEE SCHEDULE|2,495.00 PEMBINA COUNTY MEDICAL CENTER|6560000|HC HOSPICE/IP NON-RESPITE|HOSPICE SERVICE - GENERAL INPATIENT CARE NON-RESPITE [0656]|||PC STANDARD FEE SCHEDULE|186.00 PEMBINA COUNTY MEDICAL CENTER|7300000|EKG|EKG/ECG (ELECTROCARDIOGRAM) - GENERAL CLASSIFICATION [0730]|93005||PC STANDARD FEE SCHEDULE|50.00 PEMBINA COUNTY MEDICAL CENTER|7300002|ECG,TRACING|EKG/ECG (ELECTROCARDIOGRAM) - GENERAL CLASSIFICATION [0730]|93041||PC STANDARD FEE SCHEDULE|28.00 PEMBINA COUNTY MEDICAL CENTER|7310000|HC ECG MONITOR/RECORD UP TO 48 HRS|EKG/ECG (ELECTROCARDIOGRAM) - HOLTER MONITOR [0731]|93225||PC STANDARD FEE SCHEDULE|138.00 PEMBINA COUNTY MEDICAL CENTER|7400002|EEG|EEG (ELECTROENCEPHALOGRAM) - GENERAL CLASSIFICATION [0740]|95816||PC STANDARD FEE SCHEDULE|740.00 PEMBINA COUNTY MEDICAL CENTER|7500000|HC UPPER GI ENDOSCOPY,DX|GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION [0750]|43235||PC STANDARD FEE SCHEDULE|1,461.00 PEMBINA COUNTY MEDICAL CENTER|7500001|HC UPPER GI ENDOSCOPY,BIOPSY|GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION [0750]|43239||PC STANDARD FEE SCHEDULE|1,461.00 PEMBINA COUNTY MEDICAL CENTER|7500007|HC UPPER GI BALLOON DILATION|GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION [0750]|43249||PC STANDARD FEE SCHEDULE|2,171.00 PEMBINA COUNTY MEDICAL CENTER|7500008|HC UPPER GI ENDOSCOPY,TUMOR|GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION [0750]|43250||PC STANDARD FEE SCHEDULE|2,078.00 PEMBINA COUNTY MEDICAL CENTER|7500009|HC UP GI ENDOSCOPY,REMV TUMOR,SNARE|GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION [0750]|43251||PC STANDARD FEE SCHEDULE|2,078.00 PEMBINA COUNTY MEDICAL CENTER|7500023|HC DIAGNOSTIC SIGMOIDOSCOPY|GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION [0750]|45330||PC STANDARD FEE SCHEDULE|941.00 PEMBINA COUNTY MEDICAL CENTER|7500030|HC SIG W/BALLOON DILATION|GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION [0750]|45340||PC STANDARD FEE SCHEDULE|1,398.00 PEMBINA COUNTY MEDICAL CENTER|7500031|COLONOSCOPY|GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION [0750]|45378||PC STANDARD FEE SCHEDULE|1,619.00 PEMBINA COUNTY MEDICAL CENTER|7500033|COLONOSCOPY|GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION [0750]|45380||PC STANDARD FEE SCHEDULE|1,619.00 PEMBINA COUNTY MEDICAL CENTER|7500036|COLONOSCOPY|GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION [0750]|45384||PC STANDARD FEE SCHEDULE|1,619.00 PEMBINA COUNTY MEDICAL CENTER|7500037|COLONOSCOPY|GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION [0750]|45385||PC STANDARD FEE SCHEDULE|1,549.00 PEMBINA COUNTY MEDICAL CENTER|7500038|HC COLONOSCOPY DILATE STRICTURE|GASTRO-INTESTINAL (GI) - GENERAL CLASSIFICATION [0750]|45386||PC STANDARD FEE SCHEDULE|1,619.00 PEMBINA COUNTY MEDICAL CENTER|7710000|IMMUNIZATION ADMINISTRATION|PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION [0771]|90471||PC STANDARD FEE SCHEDULE|56.00 PEMBINA COUNTY MEDICAL CENTER|7710001|HC IMMUNIZATION ADMIN EA ADDL|PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION [0771]|90472||PC STANDARD FEE SCHEDULE|29.00 PEMBINA COUNTY MEDICAL CENTER|7710002|HC IMMUNIZATION ADMIN,ORAL/NASAL|PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION [0771]|90473||PC STANDARD FEE SCHEDULE|53.00 PEMBINA COUNTY MEDICAL CENTER|43753|GASTRIC INTUBATION/ASPIRATION, THERAPEUTIC|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43753||PC STANDARD FEE SCHEDULE|51.00 PEMBINA COUNTY MEDICAL CENTER|43753|GASTRIC INTUBATION/ASPIRATION, THERAPEUTIC|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43753||PC M/M HB CLINIC|51.00 PEMBINA COUNTY MEDICAL CENTER|43754|GASTRIC INTUBATION/ASPIRATION, DIAGNOSTIC, 1 SPECIMEN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43754||PC STANDARD FEE SCHEDULE|86.00 PEMBINA COUNTY MEDICAL CENTER|43754|GASTRIC INTUBATION/ASPIRATION, DIAGNOSTIC, 1 SPECIMEN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43754||PC M/M HB CLINIC|86.00 PEMBINA COUNTY MEDICAL CENTER|43755|GASTRIC INTUBATION/ASPIRATION, DIAGNOSTIC, MULTIPLE SPECIMEN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43755||PC STANDARD FEE SCHEDULE|147.00 PEMBINA COUNTY MEDICAL CENTER|43755|GASTRIC INTUBATION/ASPIRATION, DIAGNOSTIC, MULTIPLE SPECIMEN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43755||PC M/M HB CLINIC|147.00 PEMBINA COUNTY MEDICAL CENTER|43756|DUODENAL INTUBATION/ASPIRATION, DIAGNOSTIC, 1 SPECIMEN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43756||PC STANDARD FEE SCHEDULE|131.00 PEMBINA COUNTY MEDICAL CENTER|43756|DUODENAL INTUBATION/ASPIRATION, DIAGNOSTIC, 1 SPECIMEN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43756||PC M/M HB CLINIC|131.00 PEMBINA COUNTY MEDICAL CENTER|43757|DUODENAL INTUBATION/ASPIRATION, DIAGNOSTIC, MULTIPLE SPECIMEN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43757||PC STANDARD FEE SCHEDULE|196.00 PEMBINA COUNTY MEDICAL CENTER|43757|DUODENAL INTUBATION/ASPIRATION, DIAGNOSTIC, MULTIPLE SPECIMEN|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43757||PC M/M HB CLINIC|196.00 PEMBINA COUNTY MEDICAL CENTER|9200034|HC MSLT|OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION [0920]|95805||PC STANDARD FEE SCHEDULE|1,551.00 PEMBINA COUNTY MEDICAL CENTER|9200035|HC SLEEP OXIMETRY|OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION [0920]|95807||PC STANDARD FEE SCHEDULE|1,662.00 PEMBINA COUNTY MEDICAL CENTER|9200036|SLEEP STUDY|OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION [0920]|95810||PC STANDARD FEE SCHEDULE|2,212.00 PEMBINA COUNTY MEDICAL CENTER|9200037|SLEEP STUDY|OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION [0920]|95811||PC STANDARD FEE SCHEDULE|2,496.00 PEMBINA COUNTY MEDICAL CENTER|9210000|HC PACER EVAL,PROGRAM,SINGLE|OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB [0921]|93279||PC STANDARD FEE SCHEDULE|72.00 PEMBINA COUNTY MEDICAL CENTER|90460|IM ADM THRU 18YR ANY RTE 1ST/ONLY COMPT VAC/TOX|PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION [0771]|90460||PC STANDARD FEE SCHEDULE|42.00 PEMBINA COUNTY MEDICAL CENTER|9210009|CAROTID DOPPLER|OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB [0921]|93880||PC STANDARD FEE SCHEDULE|813.00 PEMBINA COUNTY MEDICAL CENTER|90461|IM ADM THRU 18YR ANY RTE ADDL VAC/TOX COMPT|PREVENTIVE CARE SERVICES - VACCINE ADMINISTRATION [0771]|90461||PC STANDARD FEE SCHEDULE|21.00 PEMBINA COUNTY MEDICAL CENTER|9210017|HC DUPLEX LOWER EXT FOLLOW UP|OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB [0921]|93926||PC STANDARD FEE SCHEDULE|629.00 PEMBINA COUNTY MEDICAL CENTER|9210020|VENOUS IMAGING|OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB [0921]|93970||PC STANDARD FEE SCHEDULE|867.00 PEMBINA COUNTY MEDICAL CENTER|9210021|SCAN EXTREMITY VEINS|OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB [0921]|93971||PC STANDARD FEE SCHEDULE|600.00 PEMBINA COUNTY MEDICAL CENTER|9210023|HC DUPLEX ABD ORGAN FOLLOW UP|OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB [0921]|93976||PC STANDARD FEE SCHEDULE|685.00 PEMBINA COUNTY MEDICAL CENTER|9210024|DUPLEX ABD VASCULATURE|OTHER DIAGNOSTIC SERVICES - PERIPHERAL VASCULAR LAB [0921]|93978||PC STANDARD FEE SCHEDULE|730.00 PEMBINA COUNTY MEDICAL CENTER|49082|ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE|PROFESSIONAL FEES - HOSPITAL VISIT [0987]|49082||PC STANDARD FEE SCHEDULE|179.00 PEMBINA COUNTY MEDICAL CENTER|49082|ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE|PROFESSIONAL FEES - HOSPITAL VISIT [0987]|49082||PC M/M HB CLINIC|179.00 PEMBINA COUNTY MEDICAL CENTER|9400003|HYDRATION,INITIAL|IV THERAPY - GENERAL CLASSIFICATION [0260]|96360||PC STANDARD FEE SCHEDULE|319.00 PEMBINA COUNTY MEDICAL CENTER|9400004|HYDRATION EA ADDL HR|IV THERAPY - GENERAL CLASSIFICATION [0260]|96361||PC STANDARD FEE SCHEDULE|41.00 PEMBINA COUNTY MEDICAL CENTER|9400005|INFUSION,INITIAL|IV THERAPY - GENERAL CLASSIFICATION [0260]|96365||PC STANDARD FEE SCHEDULE|407.00 PEMBINA COUNTY MEDICAL CENTER|9400006|INFUSION EA ADDL HR|IV THERAPY - GENERAL CLASSIFICATION [0260]|96366||PC STANDARD FEE SCHEDULE|76.00 PEMBINA COUNTY MEDICAL CENTER|49083|ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|49083||PC STANDARD FEE SCHEDULE|275.00 PEMBINA COUNTY MEDICAL CENTER|49083|ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|49083||PC M/M HB CLINIC|275.00 PEMBINA COUNTY MEDICAL CENTER|9400007|INFUSION ADDL|IV THERAPY - GENERAL CLASSIFICATION [0260]|96367||PC STANDARD FEE SCHEDULE|109.00 PEMBINA COUNTY MEDICAL CENTER|9400008|INFUSION|IV THERAPY - GENERAL CLASSIFICATION [0260]|96368||PC STANDARD FEE SCHEDULE|109.00 PEMBINA COUNTY MEDICAL CENTER|9400009|INJECTION|IV THERAPY - GENERAL CLASSIFICATION [0260]|96372||PC STANDARD FEE SCHEDULE|109.00 PEMBINA COUNTY MEDICAL CENTER|49084|PERITONEAL LAVAGE W/WO IMAGING GUIDANCE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|49084||PC STANDARD FEE SCHEDULE|250.00 PEMBINA COUNTY MEDICAL CENTER|49084|PERITONEAL LAVAGE W/WO IMAGING GUIDANCE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|49084||PC M/M HB CLINIC|250.00 PEMBINA COUNTY MEDICAL CENTER|9400011|IV PUSH|IV THERAPY - GENERAL CLASSIFICATION [0260]|96374||PC STANDARD FEE SCHEDULE|109.00 PEMBINA COUNTY MEDICAL CENTER|9400012|IV PUSH|IV THERAPY - GENERAL CLASSIFICATION [0260]|96375||PC STANDARD FEE SCHEDULE|109.00 PEMBINA COUNTY MEDICAL CENTER|9400013|IV PUSH|IV THERAPY - GENERAL CLASSIFICATION [0260]|96376||PC STANDARD FEE SCHEDULE|109.00 PEMBINA COUNTY MEDICAL CENTER|9400015|CHEMO ADMINISTRATION|RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - IV [0335]|96417||PC STANDARD FEE SCHEDULE|207.00 PEMBINA COUNTY MEDICAL CENTER|9400016|HC IMPLANTABLE PUMP REFILL/MAINT|RADIOLOGY - THERAPEUTIC AND/OR CHEMOTHERAPY ADMINISTRATION - CHEMOTHERAPY ADMINISTRATION - IV [0335]|96522||PC STANDARD FEE SCHEDULE|407.00 PEMBINA COUNTY MEDICAL CENTER|9400017|PORT FLUSH|SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM [0761]|96523||PC STANDARD FEE SCHEDULE|137.00 PEMBINA COUNTY MEDICAL CENTER|9400021|HC PHLEBOTOMY|OTHER THERAPEUTIC SERVICES - GENERAL CLASSIFICATION [0940]|99195||PC STANDARD FEE SCHEDULE|293.00 PEMBINA COUNTY MEDICAL CENTER|9420004|HC DIABETES TRAIN/INDIV 30 MIN|OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING [0942]|G0108||PC STANDARD FEE SCHEDULE|126.00 PEMBINA COUNTY MEDICAL CENTER|9420005|HC DIABETES EDUCATION|OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING [0942]|G0109||PC STANDARD FEE SCHEDULE|35.00 PEMBINA COUNTY MEDICAL CENTER|9430000|CARDIAC REHAB/PHASE I|OTHER THERAPEUTIC SERVICES - CARDIAC REHABILITATION [0943]|93797||PC STANDARD FEE SCHEDULE|81.00 PEMBINA COUNTY MEDICAL CENTER|9430001|CARD REHAB PHASE II|OTHER THERAPEUTIC SERVICES - CARDIAC REHABILITATION [0943]|93798||PC STANDARD FEE SCHEDULE|119.00 PEMBINA COUNTY MEDICAL CENTER|99224|SBSQ OBSERVATION CARE/DAY|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99224||PC STANDARD FEE SCHEDULE|96.00 PEMBINA COUNTY MEDICAL CENTER|99224|SBSQ OBSERVATION CARE/DAY|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99224||PC M/M HB CLINIC|96.00 PEMBINA COUNTY MEDICAL CENTER|99225|SBSQ OBSERVATION CARE/DAY|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99225||PC STANDARD FEE SCHEDULE|174.00 PEMBINA COUNTY MEDICAL CENTER|99225|SBSQ OBSERVATION CARE/DAY|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99225||PC M/M HB CLINIC|174.00 PEMBINA COUNTY MEDICAL CENTER|99226|SBSQ OBSERVATION CARE/DAY|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99226||PC STANDARD FEE SCHEDULE|249.00 PEMBINA COUNTY MEDICAL CENTER|99226|SBSQ OBSERVATION CARE/DAY|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99226||PC M/M HB CLINIC|249.00 PEMBINA COUNTY MEDICAL CENTER|4020075|US EXTREMITY|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76882||PC STANDARD FEE SCHEDULE|45.00 PEMBINA COUNTY MEDICAL CENTER|PC3130828|PC WEST NILE VIRUS IGM|LABORATORY - IMMUNOLOGY [0302]|86788|90|PC STANDARD FEE SCHEDULE|130.00 PEMBINA COUNTY MEDICAL CENTER|PC3130829|PC WEST NILE VIRUS IGG|LABORATORY - IMMUNOLOGY [0302]|86789|90|PC STANDARD FEE SCHEDULE|130.00 PEMBINA COUNTY MEDICAL CENTER|3520035|CT ABDOMEN/PELVIS|CT SCAN - BODY SCAN [0352]|74176||PC STANDARD FEE SCHEDULE|645.00 PEMBINA COUNTY MEDICAL CENTER|3520036|CT ABDOMEN/PELVIS|CT SCAN - BODY SCAN [0352]|74177||PC STANDARD FEE SCHEDULE|1,230.00 PEMBINA COUNTY MEDICAL CENTER|3520037|CT ABDOMEN/PELVIS|CT SCAN - BODY SCAN [0352]|74178||PC STANDARD FEE SCHEDULE|1,625.00 PEMBINA COUNTY MEDICAL CENTER|J0171|Adrenalin epinephrine inject|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J0171||PC STANDARD FEE SCHEDULE|26.00 PEMBINA COUNTY MEDICAL CENTER|80300|DRUG SCREEN LIST A ANY NMBR NON TLC DEVICES|LABORATORY - CHEMISTRY [0301]|80300||PC M/M HB CLINIC|72.00 PEMBINA COUNTY MEDICAL CENTER|90651|9VHPV VACC 2/3 DOSE SCHED IM USE|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90651||PC STANDARD FEE SCHEDULE|293.00 PEMBINA COUNTY MEDICAL CENTER|3520038|HC CTA ABDOMEN/PELVIS W/CONTRAST|CT SCAN - BODY SCAN [0352]|74174||PC STANDARD FEE SCHEDULE|2,146.00 PEMBINA COUNTY MEDICAL CENTER|3410075|HIDA IMAGE|NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES [0341]|78226||PC STANDARD FEE SCHEDULE|1,213.00 PEMBINA COUNTY MEDICAL CENTER|3410076|HIDA IMAGE|NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES [0341]|78227||PC STANDARD FEE SCHEDULE|1,685.00 PEMBINA COUNTY MEDICAL CENTER|4800062|HC PM/ICD INTERR REMOTE,TECH REVIEW & SUPPORT|CARDIOLOGY - GENERAL CLASSIFICATION [0480]|93296||PC STANDARD FEE SCHEDULE|67.00 PEMBINA COUNTY MEDICAL CENTER|4200100|HC NEG PRESSURE WOUND TX,< 50 CM|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|97605||PC STANDARD FEE SCHEDULE|129.00 PEMBINA COUNTY MEDICAL CENTER|4200101|HC NEG PRESSURE WOUND TX, > 50 CM|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|97606||PC STANDARD FEE SCHEDULE|137.00 PEMBINA COUNTY MEDICAL CENTER|1200000|HC SWING BED|ROOM & BOARD - SEMI-PRIVATE TWO BED (MEDICAL OR GENERAL) - GENERAL CLASSIFICATION [0120]|||PC STANDARD FEE SCHEDULE|331.00 PEMBINA COUNTY MEDICAL CENTER|4300034|MUSCLE TEST-EXTREMITY/TRUNK|OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION [0430]|95831||PC STANDARD FEE SCHEDULE|134.00 PEMBINA COUNTY MEDICAL CENTER|4300035|MUSCLE TEST-HAND|OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION [0430]|95832||PC STANDARD FEE SCHEDULE|118.00 PEMBINA COUNTY MEDICAL CENTER|4021000|US PROCEDURE,UNLISTED|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76999||PC STANDARD FEE SCHEDULE|126.00 PEMBINA COUNTY MEDICAL CENTER|3200300|XR-FB IN EYE|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|70030||PC STANDARD FEE SCHEDULE|83.00 PEMBINA COUNTY MEDICAL CENTER|3200301|XR-THORACIC SPINE 2 VIEWS|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|72070||PC STANDARD FEE SCHEDULE|92.00 PEMBINA COUNTY MEDICAL CENTER|4200103|HC ROM TEST-EXTREMITY/TRUNK|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|95851||PC STANDARD FEE SCHEDULE|84.00 PEMBINA COUNTY MEDICAL CENTER|4100019|HC C-PAP|RESPIRATORY SERVICES - GENERAL CLASSIFICATION [0410]|94660||PC STANDARD FEE SCHEDULE|278.00 PEMBINA COUNTY MEDICAL CENTER|4902714|EGD W/ BALLOON|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|43195||PC STANDARD FEE SCHEDULE|2,141.00 PEMBINA COUNTY MEDICAL CENTER|401536007|HC SURGICAL PATH-LEVEL III|LABORATORY PATHOLOGICAL - HISTOLOGY [0312]|88304||PC STANDARD FEE SCHEDULE|155.00 PEMBINA COUNTY MEDICAL CENTER|4020077|HC ULTRASOUND OF EXTREMITY|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76881||PC STANDARD FEE SCHEDULE|370.00 PEMBINA COUNTY MEDICAL CENTER|4500110|CRITICAL CARE ADDL 30 MIN|EMERGENCY ROOM - GENERAL CLASSIFICATION [0450]|99292||PC STANDARD FEE SCHEDULE|468.00 PEMBINA COUNTY MEDICAL CENTER|49652|LAPS REPAIR HERNIA EXCEPT INCAL/INGUN REDUCIBLE|PROFESSIONAL FEES - OPERATING ROOM [0975]|49652||PC STANDARD FEE SCHEDULE|1,701.00 PEMBINA COUNTY MEDICAL CENTER|49652|LAPS REPAIR HERNIA EXCEPT INCAL/INGUN REDUCIBLE|PROFESSIONAL FEES - OPERATING ROOM [0975]|49652||PC M/M HB CLINIC|1,701.00 PEMBINA COUNTY MEDICAL CENTER|49654|LAPAROSCOPY REPAIR INCISIONAL HERNIA REDUCIBLE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|49654||PC STANDARD FEE SCHEDULE|1,930.00 PEMBINA COUNTY MEDICAL CENTER|49654|LAPAROSCOPY REPAIR INCISIONAL HERNIA REDUCIBLE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|49654||PC M/M HB CLINIC|1,930.00 PEMBINA COUNTY MEDICAL CENTER|49656|LAPS RPR RECURRENT INCISIONAL HERNIA REDUCIBLE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|49656||PC STANDARD FEE SCHEDULE|2,091.00 PEMBINA COUNTY MEDICAL CENTER|49656|LAPS RPR RECURRENT INCISIONAL HERNIA REDUCIBLE|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|49656||PC M/M HB CLINIC|2,091.00 PEMBINA COUNTY MEDICAL CENTER|90696|DTAP-IPV VACCINE CHILD 4-6 YRS FOR IM USE|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90696||PC STANDARD FEE SCHEDULE|188.00 PEMBINA COUNTY MEDICAL CENTER|96372|PR THER PROPHYLACTIC/DX INJECTION SUBQ/IM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|96372||PC STANDARD FEE SCHEDULE|56.00 PEMBINA COUNTY MEDICAL CENTER|32554|THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING|PROFESSIONAL FEES - GENERAL CLASSIFICATION [0960]|32554||PC STANDARD FEE SCHEDULE|221.00 PEMBINA COUNTY MEDICAL CENTER|32554|THORACENTESIS NEEDLE/CATH PLEURA W/O IMAGING|PROFESSIONAL FEES - GENERAL CLASSIFICATION [0960]|32554||PC M/M HB CLINIC|221.00 PEMBINA COUNTY MEDICAL CENTER|32555|THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|32555||PC STANDARD FEE SCHEDULE|278.00 PEMBINA COUNTY MEDICAL CENTER|32555|THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|32555||PC M/M HB CLINIC|278.00 PEMBINA COUNTY MEDICAL CENTER|90672|LAIV4 VACCINE FOR INTRANASAL USE|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90672||PC STANDARD FEE SCHEDULE|30.00 PEMBINA COUNTY MEDICAL CENTER|PC3040673|PC PNEUMATIC COMPRESSION SCD'S|OTHER THERAPEUTIC SERVICES - COMPLEX MEDICAL EQUIPMENT - ANCILLARY [0947]|E0673||PC STANDARD FEE SCHEDULE|548.00 PEMBINA COUNTY MEDICAL CENTER|PC3010004|PC INPT DAILY ISOLATION|ROOM & BOARD - PRIVATE (MEDICAL OR GENERAL) - GENERAL CLASSIFICATION [0110]|||PC STANDARD FEE SCHEDULE|1,564.00 PEMBINA COUNTY MEDICAL CENTER|J7613|PR ALBUTEROL INHALATION UD|PHARMACY - GENERAL CLASSIFICATION [0250]|||PC STANDARD FEE SCHEDULE|5.00 PEMBINA COUNTY MEDICAL CENTER|3200234|HC KNEE MIN 3 VIEWS BILATERAL|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|73562||PC STANDARD FEE SCHEDULE|108.00 PEMBINA COUNTY MEDICAL CENTER|3410085|HC THYROID IMAGING W/BLOOD FLOW|NUCLEAR MEDICINE - DIAGNOSTIC PROCEDURES [0341]|78013||PC STANDARD FEE SCHEDULE|563.00 PEMBINA COUNTY MEDICAL CENTER|401588142|HC PAP SMEAR (TL)|LABORATORY PATHOLOGICAL - CYTOLOGY [0311]|88142||PC STANDARD FEE SCHEDULE|132.00 PEMBINA COUNTY MEDICAL CENTER|401536027|HC SURGICAL PATH-LEVEL IV|LABORATORY PATHOLOGICAL - HISTOLOGY [0312]|88305||PC STANDARD FEE SCHEDULE|212.00 PEMBINA COUNTY MEDICAL CENTER|J1050|Medroxyprogesterone acetate|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J1050||PC STANDARD FEE SCHEDULE|1.33 PEMBINA COUNTY MEDICAL CENTER|21011|EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ < 2CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|21011||PC STANDARD FEE SCHEDULE|647.00 PEMBINA COUNTY MEDICAL CENTER|21011|EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ < 2CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|21011||PC M/M HB CLINIC|647.00 PEMBINA COUNTY MEDICAL CENTER|21012|EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2+CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|21012||PC STANDARD FEE SCHEDULE|837.00 PEMBINA COUNTY MEDICAL CENTER|21012|EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2+CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|21012||PC M/M HB CLINIC|837.00 PEMBINA COUNTY MEDICAL CENTER|21552|EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ 3+CM|PROFESSIONAL FEES - OPERATING ROOM [0975]|21552||PC STANDARD FEE SCHEDULE|1,108.00 PEMBINA COUNTY MEDICAL CENTER|21552|EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ 3+CM|PROFESSIONAL FEES - OPERATING ROOM [0975]|21552||PC M/M HB CLINIC|1,108.00 PEMBINA COUNTY MEDICAL CENTER|21554|EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5+CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|21554||PC STANDARD FEE SCHEDULE|1,810.00 PEMBINA COUNTY MEDICAL CENTER|21554|EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5+CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|21554||PC M/M HB CLINIC|1,810.00 PEMBINA COUNTY MEDICAL CENTER|21558|RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX 5CM/>|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|21558||PC STANDARD FEE SCHEDULE|3,322.00 PEMBINA COUNTY MEDICAL CENTER|21558|RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX 5CM/>|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|21558||PC M/M HB CLINIC|3,322.00 PEMBINA COUNTY MEDICAL CENTER|21931|EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ 3+CM|PROFESSIONAL FEES - OPERATING ROOM [0975]|21931||PC STANDARD FEE SCHEDULE|1,169.00 PEMBINA COUNTY MEDICAL CENTER|21931|EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ 3+CM|PROFESSIONAL FEES - OPERATING ROOM [0975]|21931||PC M/M HB CLINIC|1,169.00 PEMBINA COUNTY MEDICAL CENTER|21932|EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|21932||PC STANDARD FEE SCHEDULE|1,641.00 PEMBINA COUNTY MEDICAL CENTER|21932|EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|21932||PC M/M HB CLINIC|1,641.00 PEMBINA COUNTY MEDICAL CENTER|21933|EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5+CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|21933||PC STANDARD FEE SCHEDULE|1,829.00 PEMBINA COUNTY MEDICAL CENTER|21933|EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5+CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|21933||PC M/M HB CLINIC|1,829.00 PEMBINA COUNTY MEDICAL CENTER|21936|RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK 5CM/>|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|21936||PC STANDARD FEE SCHEDULE|3,486.00 PEMBINA COUNTY MEDICAL CENTER|21936|RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK 5CM/>|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|21936||PC M/M HB CLINIC|3,486.00 PEMBINA COUNTY MEDICAL CENTER|22902|EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|22902||PC STANDARD FEE SCHEDULE|811.00 PEMBINA COUNTY MEDICAL CENTER|22902|EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|22902||PC M/M HB CLINIC|811.00 PEMBINA COUNTY MEDICAL CENTER|22903|EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3+CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|22903||PC STANDARD FEE SCHEDULE|1,081.00 PEMBINA COUNTY MEDICAL CENTER|22903|EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3+CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|22903||PC M/M HB CLINIC|1,081.00 PEMBINA COUNTY MEDICAL CENTER|PC3130434|PC DRUG SCREEN NON TLC DEVICES|LABORATORY - GENERAL CLASSIFICATION [0300]|80300||PC STANDARD FEE SCHEDULE|100.00 PEMBINA COUNTY MEDICAL CENTER|23071|EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3+CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|23071||PC STANDARD FEE SCHEDULE|1,042.00 PEMBINA COUNTY MEDICAL CENTER|23071|EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3+CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|23071||PC M/M HB CLINIC|1,042.00 PEMBINA COUNTY MEDICAL CENTER|24071|EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3+CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|24071||PC STANDARD FEE SCHEDULE|1,010.00 PEMBINA COUNTY MEDICAL CENTER|24071|EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3+CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|24071||PC M/M HB CLINIC|1,010.00 PEMBINA COUNTY MEDICAL CENTER|27337|EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3+CM|PROFESSIONAL FEES - OPERATING ROOM [0975]|27337||PC STANDARD FEE SCHEDULE|1,045.00 PEMBINA COUNTY MEDICAL CENTER|27337|EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3+CM|PROFESSIONAL FEES - OPERATING ROOM [0975]|27337||PC M/M HB CLINIC|1,045.00 PEMBINA COUNTY MEDICAL CENTER|27632|EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 5+CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27632||PC STANDARD FEE SCHEDULE|1,037.00 PEMBINA COUNTY MEDICAL CENTER|27632|EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 5+CM|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|27632||PC M/M HB CLINIC|1,037.00 PEMBINA COUNTY MEDICAL CENTER|43281|LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/O MESH|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43281||PC STANDARD FEE SCHEDULE|3,810.00 PEMBINA COUNTY MEDICAL CENTER|43281|LAPS RPR PARAESPHGL HRNA INCL FUNDPLSTY W/O MESH|FREE-STANDING CLINIC - CLINIC VISIT BY MEMBER TO RHC/FQHC [0521]|43281||PC M/M HB CLINIC|3,810.00 PEMBINA COUNTY MEDICAL CENTER|45171|EXC RCT TUM NOT INCL MUSCULARIS PROPRIA|PROFESSIONAL FEES - OPERATING ROOM [0975]|45171||PC STANDARD FEE SCHEDULE|1,514.00 PEMBINA COUNTY MEDICAL CENTER|45171|EXC RCT TUM NOT INCL MUSCULARIS PROPRIA|PROFESSIONAL FEES - OPERATING ROOM [0975]|45171||PC M/M HB CLINIC|1,514.00 PEMBINA COUNTY MEDICAL CENTER|45172|EXC RCT TUM INCL MUSCULARIS PROPRIA|PROFESSIONAL FEES - OPERATING ROOM [0975]|45172||PC STANDARD FEE SCHEDULE|2,036.00 PEMBINA COUNTY MEDICAL CENTER|45172|EXC RCT TUM INCL MUSCULARIS PROPRIA|PROFESSIONAL FEES - OPERATING ROOM [0975]|45172||PC M/M HB CLINIC|2,036.00 PEMBINA COUNTY MEDICAL CENTER|90670|PCV13 VACCINE FOR INTRAMUSCULAR USE|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90670||PC STANDARD FEE SCHEDULE|280.00 PEMBINA COUNTY MEDICAL CENTER|3410088|NM KIDNEY IMAGING|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|78701||PC STANDARD FEE SCHEDULE|788.00 PEMBINA COUNTY MEDICAL CENTER|J1050.01|PR DEPO-PROVERA (CAVALIER)|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J1050||PC STANDARD FEE SCHEDULE|2.00 PEMBINA COUNTY MEDICAL CENTER|PC3130004|PC BASIC METABOLIC PANEL|LABORATORY - CHEMISTRY [0301]|80048||PC STANDARD FEE SCHEDULE|58.00 PEMBINA COUNTY MEDICAL CENTER|PC3130007|PC ELECTROLYTE PANEL|LABORATORY - CHEMISTRY [0301]|80051||PC STANDARD FEE SCHEDULE|49.00 PEMBINA COUNTY MEDICAL CENTER|PC3130010|PC COMP METABOLIC PANEL|LABORATORY - CHEMISTRY [0301]|80053||PC STANDARD FEE SCHEDULE|72.00 PEMBINA COUNTY MEDICAL CENTER|PC3130014|PC CAPILLARY|LABORATORY - GENERAL CLASSIFICATION [0300]|36416||PC STANDARD FEE SCHEDULE|15.00 PEMBINA COUNTY MEDICAL CENTER|PC3130016|PC LIPID PANEL|LABORATORY - CHEMISTRY [0301]|80061||PC STANDARD FEE SCHEDULE|83.00 PEMBINA COUNTY MEDICAL CENTER|PC3130020|PC HEMATOCRIT|LABORATORY - CHEMISTRY [0301]|85014||PC STANDARD FEE SCHEDULE|16.00 PEMBINA COUNTY MEDICAL CENTER|PC3130021|PC HEMOGLOBIN|LABORATORY - CHEMISTRY [0301]|85018||PC STANDARD FEE SCHEDULE|16.00 PEMBINA COUNTY MEDICAL CENTER|PC3130022|PC HEPATIC FUNCTION PANEL|LABORATORY - CHEMISTRY [0301]|80076||PC STANDARD FEE SCHEDULE|59.00 PEMBINA COUNTY MEDICAL CENTER|PC3130023|PC MANUAL DIFF|LABORATORY - CHEMISTRY [0301]|85007||PC STANDARD FEE SCHEDULE|24.00 PEMBINA COUNTY MEDICAL CENTER|PC3130024|PC CBC AUTO DIFF|LABORATORY - HEMATOLOGY [0305]|85025||PC STANDARD FEE SCHEDULE|54.00 PEMBINA COUNTY MEDICAL CENTER|PC3130027|PC WBC|LABORATORY - CHEMISTRY [0301]|85048||PC STANDARD FEE SCHEDULE|17.00 PEMBINA COUNTY MEDICAL CENTER|PC3130032|PC PLATELET COUNT, AUTO|LABORATORY - CHEMISTRY [0301]|85049||PC STANDARD FEE SCHEDULE|31.00 PEMBINA COUNTY MEDICAL CENTER|PC3130034|PC SED RATE, NONAUTO|LABORATORY - CHEMISTRY [0301]|85651||PC STANDARD FEE SCHEDULE|26.00 PEMBINA COUNTY MEDICAL CENTER|PC3130035|PC DIGOXIN|LABORATORY - CHEMISTRY [0301]|80162||PC STANDARD FEE SCHEDULE|90.00 PEMBINA COUNTY MEDICAL CENTER|PC3130036|PC PTT|LABORATORY - CHEMISTRY [0301]|85730||PC STANDARD FEE SCHEDULE|41.00 PEMBINA COUNTY MEDICAL CENTER|PC3130070|PC CULTURE, SINGLE ORGANISM|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87081||PC STANDARD FEE SCHEDULE|39.00 PEMBINA COUNTY MEDICAL CENTER|PC3130071|PC ALBUMIN|LABORATORY - CHEMISTRY [0301]|82040||PC STANDARD FEE SCHEDULE|35.00 PEMBINA COUNTY MEDICAL CENTER|PC3130076|PC URINE MICROALBUMN SEMIQUA|LABORATORY - CHEMISTRY [0301]|82044||PC STANDARD FEE SCHEDULE|32.00 PEMBINA COUNTY MEDICAL CENTER|PC3130079|PC ALCOHOL|LABORATORY - CHEMISTRY [0301]|80320||PC STANDARD FEE SCHEDULE|73.00 PEMBINA COUNTY MEDICAL CENTER|PC3130092|PC AMYLASE|LABORATORY - CHEMISTRY [0301]|82150||PC STANDARD FEE SCHEDULE|45.00 PEMBINA COUNTY MEDICAL CENTER|PC3130094|PC SMEAR WET MOUNT|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87210||PC STANDARD FEE SCHEDULE|29.00 PEMBINA COUNTY MEDICAL CENTER|PC3130095|PC TISSUE EXAM, KOH|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87220||PC STANDARD FEE SCHEDULE|29.00 PEMBINA COUNTY MEDICAL CENTER|PC3130097|PC BILIRUBIN: TOTAL|LABORATORY - CHEMISTRY [0301]|82247||PC STANDARD FEE SCHEDULE|35.00 PEMBINA COUNTY MEDICAL CENTER|PC3130099|PC DIRECT BILIRUBIN|LABORATORY - CHEMISTRY [0301]|82248||PC STANDARD FEE SCHEDULE|35.00 PEMBINA COUNTY MEDICAL CENTER|PC3130105|PC OCCULT BLOOD, STOOL 1-3|LABORATORY - CHEMISTRY [0301]|82270||PC STANDARD FEE SCHEDULE|20.00 PEMBINA COUNTY MEDICAL CENTER|PC3130107|PC OCCULT BLOOD, STOOL 1-3|LABORATORY - CHEMISTRY [0301]|82270||PC STANDARD FEE SCHEDULE|20.00 PEMBINA COUNTY MEDICAL CENTER|PC3130108|PC OCCULT BLOOD, OTHER|LABORATORY - CHEMISTRY [0301]|82271||PC STANDARD FEE SCHEDULE|20.00 PEMBINA COUNTY MEDICAL CENTER|PC3130110|PC CALCIUM, TOTAL|LABORATORY - CHEMISTRY [0301]|82310||PC STANDARD FEE SCHEDULE|36.00 PEMBINA COUNTY MEDICAL CENTER|PC3130123|PC ANTIBODY SCREEN RBC|LABORATORY - IMMUNOLOGY [0302]|86850||PC STANDARD FEE SCHEDULE|65.00 PEMBINA COUNTY MEDICAL CENTER|PC3130126|PC CHLORIDE BLOOD|LABORATORY - CHEMISTRY [0301]|82435||PC STANDARD FEE SCHEDULE|32.00 PEMBINA COUNTY MEDICAL CENTER|PC3130129|PC COOMS DIRECT|LABORATORY - IMMUNOLOGY [0302]|86880||PC STANDARD FEE SCHEDULE|37.00 PEMBINA COUNTY MEDICAL CENTER|PC3130130|PC CHOLESTEROL|LABORATORY - CHEMISTRY [0301]|82465||PC STANDARD FEE SCHEDULE|31.00 PEMBINA COUNTY MEDICAL CENTER|PC3130131|PC COOMBS INDIRECT|LABORATORY - IMMUNOLOGY [0302]|86885||PC STANDARD FEE SCHEDULE|39.00 PEMBINA COUNTY MEDICAL CENTER|PC3130134|PC BLOOD TYPING ABO|LABORATORY - GENERAL CLASSIFICATION [0300]|86900||PC STANDARD FEE SCHEDULE|21.00 PEMBINA COUNTY MEDICAL CENTER|PC3130135|PC BLOOD TYPING RH (D)|LABORATORY - GENERAL CLASSIFICATION [0300]|86901||PC STANDARD FEE SCHEDULE|21.00 PEMBINA COUNTY MEDICAL CENTER|PC3130137|PC CPK TOTAL|LABORATORY - CHEMISTRY [0301]|82550||PC STANDARD FEE SCHEDULE|174.00 PEMBINA COUNTY MEDICAL CENTER|PC3130140|PC COMPATABILITY TEST IS|LABORATORY - IMMUNOLOGY [0302]|86920||PC STANDARD FEE SCHEDULE|78.00 PEMBINA COUNTY MEDICAL CENTER|PC3130141|PC CPK MB FRACTION ONLY|LABORATORY - CHEMISTRY [0301]|82553||PC STANDARD FEE SCHEDULE|79.00 PEMBINA COUNTY MEDICAL CENTER|PC3130142|PC COMPATABILITY ANTIGLOB|LABORATORY - IMMUNOLOGY [0302]|86922||PC STANDARD FEE SCHEDULE|105.00 PEMBINA COUNTY MEDICAL CENTER|PC3130144|PC FRESH FROZEN PLASMA THAW|LABORATORY - GENERAL CLASSIFICATION [0300]|86927||PC STANDARD FEE SCHEDULE|35.00 PEMBINA COUNTY MEDICAL CENTER|PC3130145|PC CREATININE BLOOD|LABORATORY - CHEMISTRY [0301]|82565||PC STANDARD FEE SCHEDULE|36.00 PEMBINA COUNTY MEDICAL CENTER|PC3130169|PC BLOOD, OCCULT, CARD|LABORATORY - CHEMISTRY [0301]|82272||PC STANDARD FEE SCHEDULE|20.00 PEMBINA COUNTY MEDICAL CENTER|PC3130184|PC GASES, BLOOD, PH ONLY|LABORATORY - CHEMISTRY [0301]|82800||PC STANDARD FEE SCHEDULE|58.00 PEMBINA COUNTY MEDICAL CENTER|PC3130186|PC GASES, BLOOD CALC|LABORATORY - CHEMISTRY [0301]|82805||PC STANDARD FEE SCHEDULE|193.00 PEMBINA COUNTY MEDICAL CENTER|PC3130190|PC GLUCOSE QUANTITIVE|LABORATORY - CHEMISTRY [0301]|82947||PC STANDARD FEE SCHEDULE|28.00 PEMBINA COUNTY MEDICAL CENTER|PC3130193|PC GLUCOSE, REAGENT STRIP|LABORATORY - CHEMISTRY [0301]|82948||PC STANDARD FEE SCHEDULE|23.00 PEMBINA COUNTY MEDICAL CENTER|PC3130195|PC AB HELICOBACT PYLORI|LABORATORY - IMMUNOLOGY [0302]|86677||PC STANDARD FEE SCHEDULE|100.00 PEMBINA COUNTY MEDICAL CENTER|PC3130196|PC GTT 3 SPECIMENS|LABORATORY - CHEMISTRY [0301]|82951||PC STANDARD FEE SCHEDULE|88.00 PEMBINA COUNTY MEDICAL CENTER|PC3130199|PC GTT EACH ADD'L SPECIMEN|LABORATORY - CHEMISTRY [0301]|82952||PC STANDARD FEE SCHEDULE|27.00 PEMBINA COUNTY MEDICAL CENTER|PC3130205|PC GGT|LABORATORY - CHEMISTRY [0301]|82977||PC STANDARD FEE SCHEDULE|50.00 PEMBINA COUNTY MEDICAL CENTER|PC3130208|PC BNP|LABORATORY - CHEMISTRY [0301]|83880||PC STANDARD FEE SCHEDULE|228.00 PEMBINA COUNTY MEDICAL CENTER|PC3130222|PC HEMOGLOBIN GLYCATED|LABORATORY - CHEMISTRY [0301]|83036||PC STANDARD FEE SCHEDULE|67.00 PEMBINA COUNTY MEDICAL CENTER|PC3130244|PC LDH|LABORATORY - CHEMISTRY [0301]|83615||PC STANDARD FEE SCHEDULE|42.00 PEMBINA COUNTY MEDICAL CENTER|PC3130250|PC OCCULT BLOOD,FECAL,TUBE|LABORATORY - CHEMISTRY [0301]|82274||PC STANDARD FEE SCHEDULE|108.00 PEMBINA COUNTY MEDICAL CENTER|PC3130253|PC LIPASE|LABORATORY - CHEMISTRY [0301]|83690||PC STANDARD FEE SCHEDULE|47.00 PEMBINA COUNTY MEDICAL CENTER|PC3130260|PC MAGNESIUM|LABORATORY - CHEMISTRY [0301]|83735||PC STANDARD FEE SCHEDULE|46.00 PEMBINA COUNTY MEDICAL CENTER|PC3130267|PC MYOGLOBIN|LABORATORY - CHEMISTRY [0301]|83874||PC STANDARD FEE SCHEDULE|89.00 PEMBINA COUNTY MEDICAL CENTER|PC3130285|PC PHOSPHATASE ALKALINE|LABORATORY - CHEMISTRY [0301]|84075||PC STANDARD FEE SCHEDULE|101.00 PEMBINA COUNTY MEDICAL CENTER|PC3130299|PC POTASSIUM SERUM|LABORATORY - CHEMISTRY [0301]|84132||PC STANDARD FEE SCHEDULE|32.00 PEMBINA COUNTY MEDICAL CENTER|PC3130309|PC PSA TOTAL DIAGNOSTIC|LABORATORY - CHEMISTRY [0301]|84153|90|PC STANDARD FEE SCHEDULE|164.00 PEMBINA COUNTY MEDICAL CENTER|PC3130314|PC PROTEIN TOTAL|LABORATORY - CHEMISTRY [0301]|84155|90|PC STANDARD FEE SCHEDULE|41.00 PEMBINA COUNTY MEDICAL CENTER|PC3130322|PC SODIUM, SERUM|LABORATORY - CHEMISTRY [0301]|84295||PC STANDARD FEE SCHEDULE|34.00 PEMBINA COUNTY MEDICAL CENTER|PC3130328|PC SEMEN ANALYSIS|LABORATORY - OTHER LABORATORY [0309]|89321||PC STANDARD FEE SCHEDULE|82.00 PEMBINA COUNTY MEDICAL CENTER|PC3130342|PC TSH|LABORATORY - CHEMISTRY [0301]|84443||PC STANDARD FEE SCHEDULE|114.00 PEMBINA COUNTY MEDICAL CENTER|PC3130346|PC SGOT/AST|LABORATORY - CHEMISTRY [0301]|84450||PC STANDARD FEE SCHEDULE|36.00 PEMBINA COUNTY MEDICAL CENTER|PC3130350|PC SGPT/ALT|LABORATORY - CHEMISTRY [0301]|84460||PC STANDARD FEE SCHEDULE|37.00 PEMBINA COUNTY MEDICAL CENTER|PC3130353|PC TRIGLYCERIDES|LABORATORY - CHEMISTRY [0301]|84478||PC STANDARD FEE SCHEDULE|39.00 PEMBINA COUNTY MEDICAL CENTER|PC3130356|PC TROPONIN, QUANTITATIVE|LABORATORY - CHEMISTRY [0301]|84484||PC STANDARD FEE SCHEDULE|46.00 PEMBINA COUNTY MEDICAL CENTER|PC3130358|PC BUN|LABORATORY - CHEMISTRY [0301]|84520||PC STANDARD FEE SCHEDULE|28.00 PEMBINA COUNTY MEDICAL CENTER|PC3130359|PC URIC ACID, BLOOD|LABORATORY - CHEMISTRY [0301]|84550||PC STANDARD FEE SCHEDULE|32.00 PEMBINA COUNTY MEDICAL CENTER|PC3130365|PC HCG-QUALITIVE|LABORATORY - CHEMISTRY [0301]|84703||PC STANDARD FEE SCHEDULE|51.00 PEMBINA COUNTY MEDICAL CENTER|PC3130372|PC C-REACTIVE PROTEIN|LABORATORY - IMMUNOLOGY [0302]|86140||PC STANDARD FEE SCHEDULE|36.00 PEMBINA COUNTY MEDICAL CENTER|PC3130381|PC HETEROPHILE AB SCREEN/MON|LABORATORY - IMMUNOLOGY [0302]|86308||PC STANDARD FEE SCHEDULE|36.00 PEMBINA COUNTY MEDICAL CENTER|PC3130397|PC AB HELICOBACTER PYLORI|LABORATORY - IMMUNOLOGY [0302]|83009||PC STANDARD FEE SCHEDULE|455.00 PEMBINA COUNTY MEDICAL CENTER|PC3130403|PC ANTIBODY INFLUENZA VIRUS|LABORATORY - IMMUNOLOGY [0302]|86710||PC STANDARD FEE SCHEDULE|92.00 PEMBINA COUNTY MEDICAL CENTER|PC3130413|PC VENIPUNCTURE|LABORATORY - GENERAL CLASSIFICATION [0300]|36415||PC STANDARD FEE SCHEDULE|15.00 PEMBINA COUNTY MEDICAL CENTER|PC3130414|PC COMMERCIAL HANDLING FEE|LABORATORY - CHEMISTRY [0301]|99001||PC STANDARD FEE SCHEDULE|35.00 PEMBINA COUNTY MEDICAL CENTER|PC3130415|PC BLEEDING TIME|LABORATORY - CHEMISTRY [0301]|85002||PC STANDARD FEE SCHEDULE|32.00 PEMBINA COUNTY MEDICAL CENTER|PC3130417|PC RBC|LABORATORY - CHEMISTRY [0301]|85041||PC STANDARD FEE SCHEDULE|21.00 PEMBINA COUNTY MEDICAL CENTER|PC3130422|PC PROTHROMBIN TIME|LABORATORY - HEMATOLOGY [0305]|85610||PC STANDARD FEE SCHEDULE|28.00 PEMBINA COUNTY MEDICAL CENTER|PC3130425|PC UA AUTO W/MICRO|LABORATORY - UROLOGY [0307]|81001||PC STANDARD FEE SCHEDULE|23.00 PEMBINA COUNTY MEDICAL CENTER|PC3130426|PC URINE PREGNANCY TEST|LABORATORY - UROLOGY [0307]|81025||PC STANDARD FEE SCHEDULE|44.00 PEMBINA COUNTY MEDICAL CENTER|PC3130427|PC UA VOLUME MEASURE|LABORATORY - UROLOGY [0307]|81050||PC STANDARD FEE SCHEDULE|21.00 PEMBINA COUNTY MEDICAL CENTER|PC3130428|PC UA AUTO W/O MICRO|LABORATORY - UROLOGY [0307]|81003||PC STANDARD FEE SCHEDULE|16.00 PEMBINA COUNTY MEDICAL CENTER|PC3130451|PC PSA, TOTAL SCREENING|LABORATORY - CHEMISTRY [0301]|G0103||PC STANDARD FEE SCHEDULE|125.00 PEMBINA COUNTY MEDICAL CENTER|PC3130475|PC CATH COLLECT SPECI:SINGLE|LABORATORY - GENERAL CLASSIFICATION [0300]|36415||PC STANDARD FEE SCHEDULE|15.00 PEMBINA COUNTY MEDICAL CENTER|PC3130476|PC CATH COLLECT SPEC: MULTIP|LABORATORY - GENERAL CLASSIFICATION [0300]|P9615||PC STANDARD FEE SCHEDULE|6.00 PEMBINA COUNTY MEDICAL CENTER|PC3130477|PC TRAVEL;PER MILE CHG|LABORATORY - GENERAL CLASSIFICATION [0300]|P9603||PC STANDARD FEE SCHEDULE|3.00 PEMBINA COUNTY MEDICAL CENTER|PC3130478|PC TRAVEL: PER TRIP|LABORATORY - GENERAL CLASSIFICATION [0300]|P9604||PC STANDARD FEE SCHEDULE|8.00 PEMBINA COUNTY MEDICAL CENTER|PC3130538|PC GENERAL HEALTH PANEL|LABORATORY - CHEMISTRY [0301]|80050||PC STANDARD FEE SCHEDULE|239.00 PEMBINA COUNTY MEDICAL CENTER|PC3130808|PC CBC W/O AUTO DIFF|LABORATORY - HEMATOLOGY [0305]|85027||PC STANDARD FEE SCHEDULE|45.00 PEMBINA COUNTY MEDICAL CENTER|PC3130817|PC HLA-B27|LABORATORY - IMMUNOLOGY [0302]|86812|90|PC STANDARD FEE SCHEDULE|241.00 PEMBINA COUNTY MEDICAL CENTER|PC3140312|PC SPECIAL STAIN GROUP 1|LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION [0310]|88312||PC STANDARD FEE SCHEDULE|215.00 PEMBINA COUNTY MEDICAL CENTER|PC3140342|PC IMMUNOHISTOCHEMISTRY|LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION [0310]|88342||PC STANDARD FEE SCHEDULE|203.00 PEMBINA COUNTY MEDICAL CENTER|PC3317074|PC APL STABIL TB.PPD 1ML|LABORATORY - IMMUNOLOGY [0302]|||PC STANDARD FEE SCHEDULE|147.00 PEMBINA COUNTY MEDICAL CENTER|PC3130008|PC ANTIBODY BORELIA LYME|LABORATORY - IMMUNOLOGY [0302]|86618|90|PC STANDARD FEE SCHEDULE|177.00 PEMBINA COUNTY MEDICAL CENTER|PC3130011|PC ANTIBODY GIARDIA LAMBIA|LABORATORY - IMMUNOLOGY [0302]|86674|90|PC STANDARD FEE SCHEDULE|97.00 PEMBINA COUNTY MEDICAL CENTER|PC3130012|PC ANTIBODY HEMOPHILUS FLU|LABORATORY - IMMUNOLOGY [0302]|86684|90|PC STANDARD FEE SCHEDULE|90.00 PEMBINA COUNTY MEDICAL CENTER|PC3130013|PC OBSTETRIC PANEL|LABORATORY - CHEMISTRY [0301]|80055|90|PC STANDARD FEE SCHEDULE|356.00 PEMBINA COUNTY MEDICAL CENTER|PC3130018|PC ACUTE HEPATITIS PANEL|LABORATORY - CHEMISTRY [0301]|80074|90|PC STANDARD FEE SCHEDULE|308.00 PEMBINA COUNTY MEDICAL CENTER|PC3130030|PC FIBRINOGEN ACTIVITY|LABORATORY - CHEMISTRY [0301]|85384|90|PC STANDARD FEE SCHEDULE|124.00 PEMBINA COUNTY MEDICAL CENTER|PC3130031|PC CARBAMEZEPINE; TOTAL|LABORATORY - CHEMISTRY [0301]|80156|90|PC STANDARD FEE SCHEDULE|100.00 PEMBINA COUNTY MEDICAL CENTER|PC3130033|PC CYCLOSPORINE|LABORATORY - CHEMISTRY [0301]|80158|90|PC STANDARD FEE SCHEDULE|123.00 PEMBINA COUNTY MEDICAL CENTER|PC3130038|PC VALPORIC ACID|LABORATORY - CHEMISTRY [0301]|80164|90|PC STANDARD FEE SCHEDULE|92.00 PEMBINA COUNTY MEDICAL CENTER|PC3130039|PC GENTAMYCIN|LABORATORY - CHEMISTRY [0301]|80170|90|PC STANDARD FEE SCHEDULE|112.00 PEMBINA COUNTY MEDICAL CENTER|PC3130041|PC LITHIUM|LABORATORY - CHEMISTRY [0301]|80178|90|PC STANDARD FEE SCHEDULE|46.00 PEMBINA COUNTY MEDICAL CENTER|PC3130042|PC ANTIBODY RSV|LABORATORY - IMMUNOLOGY [0302]|86756|90|PC STANDARD FEE SCHEDULE|88.00 PEMBINA COUNTY MEDICAL CENTER|PC3130043|PC ANTIBODY ROTAVIRUS|LABORATORY - IMMUNOLOGY [0302]|86759|90|PC STANDARD FEE SCHEDULE|90.00 PEMBINA COUNTY MEDICAL CENTER|PC3130044|PC PHENOBARBITAL|LABORATORY - CHEMISTRY [0301]|80184|90|PC STANDARD FEE SCHEDULE|79.00 PEMBINA COUNTY MEDICAL CENTER|PC3130045|PC ANTIBODY TOXOPLASMA|LABORATORY - IMMUNOLOGY [0302]|86777|90|PC STANDARD FEE SCHEDULE|97.00 PEMBINA COUNTY MEDICAL CENTER|PC3130047|PC PHENYTOIN, TOTAL|LABORATORY - CHEMISTRY [0301]|80185|90|PC STANDARD FEE SCHEDULE|90.00 PEMBINA COUNTY MEDICAL CENTER|PC3130048|PC ANTIBODY VARICELLA ZOSTER|LABORATORY - IMMUNOLOGY [0302]|86787|90|PC STANDARD FEE SCHEDULE|159.00 PEMBINA COUNTY MEDICAL CENTER|PC3130049|PC ANTIBODY VARICELLA ZOSTER|LABORATORY - IMMUNOLOGY [0302]|86787|90|PC STANDARD FEE SCHEDULE|159.00 PEMBINA COUNTY MEDICAL CENTER|PC3130050|PC PRIMIDONE (MYSOLINE)|LABORATORY - CHEMISTRY [0301]|80188|90|PC STANDARD FEE SCHEDULE|113.00 PEMBINA COUNTY MEDICAL CENTER|PC3130051|PC CULTURE BLOOD|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87040|90|PC STANDARD FEE SCHEDULE|70.00 PEMBINA COUNTY MEDICAL CENTER|PC3130052|PC CULTURE STOOL|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87045|90|PC STANDARD FEE SCHEDULE|65.00 PEMBINA COUNTY MEDICAL CENTER|PC3130054|PC CULTURE-STOOL ADDL PATHO|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87046|90|PC STANDARD FEE SCHEDULE|65.00 PEMBINA COUNTY MEDICAL CENTER|PC3130057|PC CULTURE THROAT OR NOSE|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87070|90|PC STANDARD FEE SCHEDULE|59.00 PEMBINA COUNTY MEDICAL CENTER|PC3130058|PC THEOPHYLLINE|LABORATORY - CHEMISTRY [0301]|80198|90|PC STANDARD FEE SCHEDULE|96.00 PEMBINA COUNTY MEDICAL CENTER|PC3130059|PC CULTURE, OTHER SOURCE|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87070|90|PC STANDARD FEE SCHEDULE|59.00 PEMBINA COUNTY MEDICAL CENTER|PC3130060|PC TOBRAMYCIN|LABORATORY - CHEMISTRY [0301]|80200|90|PC STANDARD FEE SCHEDULE|109.00 PEMBINA COUNTY MEDICAL CENTER|PC3130061|PC VANCOMYCIN|LABORATORY - CHEMISTRY [0301]|80202|90|PC STANDARD FEE SCHEDULE|92.00 PEMBINA COUNTY MEDICAL CENTER|PC3130065|PC ACETOMINOPHEN|LABORATORY - CHEMISTRY [0301]|82003|90|PC STANDARD FEE SCHEDULE|137.00 PEMBINA COUNTY MEDICAL CENTER|PC3130067|PC CULTURE ANAEROBIC|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87075|90|PC STANDARD FEE SCHEDULE|65.00 PEMBINA COUNTY MEDICAL CENTER|PC3130068|PC ACTH|LABORATORY - CHEMISTRY [0301]|82024|90|PC STANDARD FEE SCHEDULE|262.00 PEMBINA COUNTY MEDICAL CENTER|PC3130069|PC CULTURE ADDITIONAL ID|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87077|90|PC STANDARD FEE SCHEDULE|56.00 PEMBINA COUNTY MEDICAL CENTER|PC3130072|PC CLTR URNE ADD TO QUAN/KIT|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87086|90|PC STANDARD FEE SCHEDULE|48.00 PEMBINA COUNTY MEDICAL CENTER|PC3130073|PC CULTURE FUNGUS, OTHER|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87102|90|PC STANDARD FEE SCHEDULE|58.00 PEMBINA COUNTY MEDICAL CENTER|PC3130074|PC CULTURE-YEAST IDENTIFICAT|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87106|90|PC STANDARD FEE SCHEDULE|70.00 PEMBINA COUNTY MEDICAL CENTER|PC3130075|PC CULTURE-FUNGAL ID|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87107|90|PC STANDARD FEE SCHEDULE|70.00 PEMBINA COUNTY MEDICAL CENTER|PC3130077|PC CULTURE CHLAMYDIA|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87110|90|PC STANDARD FEE SCHEDULE|104.00 PEMBINA COUNTY MEDICAL CENTER|PC3130078|PC CULTURE ACID FAST BACILLI|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87116|90|PC STANDARD FEE SCHEDULE|27.00 PEMBINA COUNTY MEDICAL CENTER|PC3130080|PC PH - BODY FLUID|LABORATORY - CHEMISTRY [0301]|83986|90|PC STANDARD FEE SCHEDULE|26.00 PEMBINA COUNTY MEDICAL CENTER|PC3130082|PC OVA AND PARASITES SMEAR|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87177|90|PC STANDARD FEE SCHEDULE|61.00 PEMBINA COUNTY MEDICAL CENTER|PC3130083|PC ALDOSTERONE|LABORATORY - CHEMISTRY [0301]|82088|90|PC STANDARD FEE SCHEDULE|446.00 PEMBINA COUNTY MEDICAL CENTER|PC3130084|PC SENSITIVITY & DIFFUSION|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87181|90|PC STANDARD FEE SCHEDULE|34.00 PEMBINA COUNTY MEDICAL CENTER|PC3130085|PC ALPHA-1 ANTITRYPSIN TOTAL|LABORATORY - CHEMISTRY [0301]|82103|90|PC STANDARD FEE SCHEDULE|176.00 PEMBINA COUNTY MEDICAL CENTER|PC3130086|PC SENSITIVITY/MIC|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87186|90|PC STANDARD FEE SCHEDULE|177.00 PEMBINA COUNTY MEDICAL CENTER|PC3130087|PC ALPHA FETOPROTEIN, SERUM|LABORATORY - CHEMISTRY [0301]|82105|90|PC STANDARD FEE SCHEDULE|202.00 PEMBINA COUNTY MEDICAL CENTER|PC3130088|PC SMEAR ROUTINE STAIN|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87205|90|PC STANDARD FEE SCHEDULE|29.00 PEMBINA COUNTY MEDICAL CENTER|PC3130089|PC AMINOLEVULINIC ACID (ALA)|LABORATORY - CHEMISTRY [0301]|82135|90|PC STANDARD FEE SCHEDULE|112.00 PEMBINA COUNTY MEDICAL CENTER|PC3130090|PC AMMONIA|LABORATORY - CHEMISTRY [0301]|82140|90|PC STANDARD FEE SCHEDULE|100.00 PEMBINA COUNTY MEDICAL CENTER|PC3130091|PC SMEAR FLOURESC/ACID FAST|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87206|90|PC STANDARD FEE SCHEDULE|37.00 PEMBINA COUNTY MEDICAL CENTER|PC3130096|PC ANGIOTENSIN I/CONVER ENZY|LABORATORY - CHEMISTRY [0301]|82164|90|PC STANDARD FEE SCHEDULE|100.00 PEMBINA COUNTY MEDICAL CENTER|PC3130098|PC TOXIN/ANTITOXIN ASSAY|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87230|90|PC STANDARD FEE SCHEDULE|134.00 PEMBINA COUNTY MEDICAL CENTER|PC3130100|PC VIRUS ID TISSUE CULTURE|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87252|90|PC STANDARD FEE SCHEDULE|176.00 PEMBINA COUNTY MEDICAL CENTER|PC3130103|PC ANTIGEN MULTIPLE STEP NOS|LABORATORY - IMMUNOLOGY [0302]|87449|90|PC STANDARD FEE SCHEDULE|82.00 PEMBINA COUNTY MEDICAL CENTER|PC3130104|PC INF AN\GNT DNA/ RNA NES|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87797|90|PC STANDARD FEE SCHEDULE|136.00 PEMBINA COUNTY MEDICAL CENTER|PC3130111|PC SMEAR W/ INTERP/NOT PAPS|LABORATORY PATHOLOGICAL - CYTOLOGY [0311]|88104|90|PC STANDARD FEE SCHEDULE|128.00 PEMBINA COUNTY MEDICAL CENTER|PC3130113|PC CALCIUM URINE, QUANTIT|LABORATORY - CHEMISTRY [0301]|82340|90|PC STANDARD FEE SCHEDULE|42.00 PEMBINA COUNTY MEDICAL CENTER|PC3130116|PC CALCULUS ANALYSIS, QUALIT|LABORATORY - CHEMISTRY [0301]|82355|90|PC STANDARD FEE SCHEDULE|80.00 PEMBINA COUNTY MEDICAL CENTER|PC3130118|PC CARBON MONOXIDE QUANT|LABORATORY - CHEMISTRY [0301]|82375|90|PC STANDARD FEE SCHEDULE|53.00 PEMBINA COUNTY MEDICAL CENTER|PC3130119|PC FETAL KLEI-BETKE|LABORATORY - HEMATOLOGY [0305]|85460|90|PC STANDARD FEE SCHEDULE|53.00 PEMBINA COUNTY MEDICAL CENTER|PC3130120|PC CEA|LABORATORY - CHEMISTRY [0301]|82378|90|PC STANDARD FEE SCHEDULE|129.00 PEMBINA COUNTY MEDICAL CENTER|PC3130121|PC HGB ROSETTE|LABORATORY - HEMATOLOGY [0305]|85461|90|PC STANDARD FEE SCHEDULE|46.00 PEMBINA COUNTY MEDICAL CENTER|PC3130122|PC CAROTENE|LABORATORY - CHEMISTRY [0301]|82380|90|PC STANDARD FEE SCHEDULE|62.00 PEMBINA COUNTY MEDICAL CENTER|PC3130124|PC CATECHOLIMINES, FRACT|LABORATORY - CHEMISTRY [0301]|82384|90|PC STANDARD FEE SCHEDULE|172.00 PEMBINA COUNTY MEDICAL CENTER|PC3130127|PC ANTIBODY IDENTIFY, RBC|LABORATORY - IMMUNOLOGY [0302]|86870|90|PC STANDARD FEE SCHEDULE|123.00 PEMBINA COUNTY MEDICAL CENTER|PC3130128|PC CHLORIDE URINE|LABORATORY - CHEMISTRY [0301]|82436|90|PC STANDARD FEE SCHEDULE|35.00 PEMBINA COUNTY MEDICAL CENTER|PC3130132|PC CORTISOL FREE|LABORATORY - CHEMISTRY [0301]|82530|90|PC STANDARD FEE SCHEDULE|113.00 PEMBINA COUNTY MEDICAL CENTER|PC3130133|PC CORTISOL, TOTAL|LABORATORY - CHEMISTRY [0301]|82533|90|PC STANDARD FEE SCHEDULE|264.00 PEMBINA COUNTY MEDICAL CENTER|PC3130136|PC BLOOD TYPE ANTIGEN SCREEN|LABORATORY - IMMUNOLOGY [0302]|86902|90|PC STANDARD FEE SCHEDULE|27.00 PEMBINA COUNTY MEDICAL CENTER|PC3130138|PC BLOOD TYPING RBC ANTIGEN|LABORATORY - IMMUNOLOGY [0302]|86905|90|PC STANDARD FEE SCHEDULE|27.00 PEMBINA COUNTY MEDICAL CENTER|PC3130146|PC POOLING OF PLATELETS|LABORATORY - IMMUNOLOGY [0302]|86965|90|PC STANDARD FEE SCHEDULE|89.00 PEMBINA COUNTY MEDICAL CENTER|PC3130147|PC CREATININE OTHER SOURCE|LABORATORY - CHEMISTRY [0301]|82570|90|PC STANDARD FEE SCHEDULE|36.00 PEMBINA COUNTY MEDICAL CENTER|PC3130149|PC CREATININE CLEARANCE|LABORATORY - CHEMISTRY [0301]|82575|90|PC STANDARD FEE SCHEDULE|65.00 PEMBINA COUNTY MEDICAL CENTER|PC3130152|PC CYANOCOBALAMIN (VIT B12)|LABORATORY - CHEMISTRY [0301]|82607|90|PC STANDARD FEE SCHEDULE|103.00 PEMBINA COUNTY MEDICAL CENTER|PC3130153|PC FACTOR VIII|LABORATORY - HEMATOLOGY [0305]|85240|90|PC STANDARD FEE SCHEDULE|114.00 PEMBINA COUNTY MEDICAL CENTER|PC3130154|PC FACTOR IX|LABORATORY - HEMATOLOGY [0305]|85250|90|PC STANDARD FEE SCHEDULE|130.00 PEMBINA COUNTY MEDICAL CENTER|PC3130155|PC DHEA SULFATE|LABORATORY - CHEMISTRY [0301]|82627|90|PC STANDARD FEE SCHEDULE|322.00 PEMBINA COUNTY MEDICAL CENTER|PC3130156|PC FACTOR X|LABORATORY - HEMATOLOGY [0305]|85260|90|PC STANDARD FEE SCHEDULE|123.00 PEMBINA COUNTY MEDICAL CENTER|PC3130157|PC FACTOR XI|LABORATORY - HEMATOLOGY [0305]|85270|90|PC STANDARD FEE SCHEDULE|123.00 PEMBINA COUNTY MEDICAL CENTER|PC3130158|PC ERYTHROPOIETIN|LABORATORY - CHEMISTRY [0301]|82668|90|PC STANDARD FEE SCHEDULE|266.00 PEMBINA COUNTY MEDICAL CENTER|PC3130159|PC FACTOR XII|LABORATORY - HEMATOLOGY [0305]|85280|90|PC STANDARD FEE SCHEDULE|131.00 PEMBINA COUNTY MEDICAL CENTER|PC3130160|PC PROTEIN S, TOTAL|LABORATORY - HEMATOLOGY [0305]|85305|90|PC STANDARD FEE SCHEDULE|80.00 PEMBINA COUNTY MEDICAL CENTER|PC3130161|PC ESTRADIOL|LABORATORY - CHEMISTRY [0301]|82670|90|PC STANDARD FEE SCHEDULE|189.00 PEMBINA COUNTY MEDICAL CENTER|PC3130162|PC PLATELET NEUTRALIZATION|LABORATORY - HEMATOLOGY [0305]|85597|90|PC STANDARD FEE SCHEDULE|104.00 PEMBINA COUNTY MEDICAL CENTER|PC3130164|PC ESTRIOL|LABORATORY - CHEMISTRY [0301]|82677|90|PC STANDARD FEE SCHEDULE|162.00 PEMBINA COUNTY MEDICAL CENTER|PC3130165|PC INFECT AGNT DET;AMPLIFIED|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87801|90|PC STANDARD FEE SCHEDULE|473.00 PEMBINA COUNTY MEDICAL CENTER|PC3130167|PC FERRITIN|LABORATORY - CHEMISTRY [0301]|82728|90|PC STANDARD FEE SCHEDULE|92.00 PEMBINA COUNTY MEDICAL CENTER|PC3130168|PC CARBAMAZEPINE; FREE|LABORATORY - CHEMISTRY [0301]|80157|90|PC STANDARD FEE SCHEDULE|90.00 PEMBINA COUNTY MEDICAL CENTER|PC3130170|PC FOLIC ACID SERUM|LABORATORY - CHEMISTRY [0301]|82746|90|PC STANDARD FEE SCHEDULE|101.00 PEMBINA COUNTY MEDICAL CENTER|PC3130173|PC FOLIC ACID RBC|LABORATORY - CHEMISTRY [0301]|82747|90|PC STANDARD FEE SCHEDULE|116.00 PEMBINA COUNTY MEDICAL CENTER|PC3130176|PC GAMMAGLOBULIN A,D,G,M EAC|LABORATORY - CHEMISTRY [0301]|82784|90|PC STANDARD FEE SCHEDULE|105.00 PEMBINA COUNTY MEDICAL CENTER|PC3130179|PC GAMMAGLOBULIN IGE|LABORATORY - CHEMISTRY [0301]|82785|90|PC STANDARD FEE SCHEDULE|155.00 PEMBINA COUNTY MEDICAL CENTER|PC3130182|PC IMMUNOGLOBULIN SUBCLASS|LABORATORY - CHEMISTRY [0301]|82787|90|PC STANDARD FEE SCHEDULE|32.00 PEMBINA COUNTY MEDICAL CENTER|PC3130185|PC CYTO THIN PREP PAP|LABORATORY PATHOLOGICAL - CYTOLOGY [0311]|88142|90|PC STANDARD FEE SCHEDULE|137.00 PEMBINA COUNTY MEDICAL CENTER|PC3130187|PC CYTO, PHYSICIAN INTERP|LABORATORY PATHOLOGICAL - CYTOLOGY [0311]|88141|90|PC STANDARD FEE SCHEDULE|61.00 PEMBINA COUNTY MEDICAL CENTER|PC3130188|PC GASTRIN|LABORATORY - CHEMISTRY [0301]|82941|90|PC STANDARD FEE SCHEDULE|119.00 PEMBINA COUNTY MEDICAL CENTER|PC3130189|PC HPV TESTING|LABORATORY PATHOLOGICAL - CYTOLOGY [0311]|88365|90|PC STANDARD FEE SCHEDULE|344.00 PEMBINA COUNTY MEDICAL CENTER|PC3130191|PC IMMUNO TUMOR ANTI;CA 27.29|LABORATORY - IMMUNOLOGY [0302]|86300|90|PC STANDARD FEE SCHEDULE|230.00 PEMBINA COUNTY MEDICAL CENTER|PC3130192|PC BETA-2 MICROGLOBULIN|LABORATORY - CHEMISTRY [0301]|82232|90|PC STANDARD FEE SCHEDULE|111.00 PEMBINA COUNTY MEDICAL CENTER|PC3130194|PC SEROTONIN|LABORATORY - CHEMISTRY [0301]|84260|90|PC STANDARD FEE SCHEDULE|208.00 PEMBINA COUNTY MEDICAL CENTER|PC3130197|PC ETHOSUXIMIDE|LABORATORY - CHEMISTRY [0301]|80168|90|PC STANDARD FEE SCHEDULE|111.00 PEMBINA COUNTY MEDICAL CENTER|PC3130198|PC VITAMIN D|LABORATORY - CHEMISTRY [0301]|82306|90|PC STANDARD FEE SCHEDULE|299.00 PEMBINA COUNTY MEDICAL CENTER|PC3130200|PC VITAMIN A|LABORATORY - CHEMISTRY [0301]|84590|90|PC STANDARD FEE SCHEDULE|205.00 PEMBINA COUNTY MEDICAL CENTER|PC3130201|PC ASSAY OF CRYOFIBRINOGEN|LABORATORY - CHEMISTRY [0301]|82585|90|PC STANDARD FEE SCHEDULE|59.00 PEMBINA COUNTY MEDICAL CENTER|PC3130202|PC ASSAY OF CRYOGLOBULIN|LABORATORY - CHEMISTRY [0301]|82595|90|PC STANDARD FEE SCHEDULE|32.00 PEMBINA COUNTY MEDICAL CENTER|PC3130206|PC CHEMILUMINESCENT ASSAY|LABORATORY - CHEMISTRY [0301]|82397|90|PC STANDARD FEE SCHEDULE|96.00 PEMBINA COUNTY MEDICAL CENTER|PC3130209|PC FSH|LABORATORY - CHEMISTRY [0301]|83001|90|PC STANDARD FEE SCHEDULE|126.00 PEMBINA COUNTY MEDICAL CENTER|PC3130212|PC LH|LABORATORY - CHEMISTRY [0301]|83002|90|PC STANDARD FEE SCHEDULE|126.00 PEMBINA COUNTY MEDICAL CENTER|PC3130215|PC GROWTH HORMONE|LABORATORY - CHEMISTRY [0301]|83003|90|PC STANDARD FEE SCHEDULE|176.00 PEMBINA COUNTY MEDICAL CENTER|PC3130217|PC HAPTOGLOBIN QUANTITIVE|LABORATORY - CHEMISTRY [0301]|83010|90|PC STANDARD FEE SCHEDULE|86.00 PEMBINA COUNTY MEDICAL CENTER|PC3130218|PC HEMOGLOBIN ELECTRO|LABORATORY - CHEMISTRY [0301]|83020|90|PC STANDARD FEE SCHEDULE|20.00 PEMBINA COUNTY MEDICAL CENTER|PC3130224|PC HYDROXINDOLACETIC ACID/HI|LABORATORY - CHEMISTRY [0301]|83497|90|PC STANDARD FEE SCHEDULE|82.00 PEMBINA COUNTY MEDICAL CENTER|PC3130226|PC IMMUNOASSAY RIA|LABORATORY - CHEMISTRY [0301]|83519|90|PC STANDARD FEE SCHEDULE|251.00 PEMBINA COUNTY MEDICAL CENTER|PC3130227|TISSUE TRANSGL IGG|LABORATORY - CHEMISTRY [0301]|83516|90|PC STANDARD FEE SCHEDULE|238.00 PEMBINA COUNTY MEDICAL CENTER|PC3130229|PC IMMUNOASSAY NOS|LABORATORY - CHEMISTRY [0301]|83520|90|PC STANDARD FEE SCHEDULE|398.00 PEMBINA COUNTY MEDICAL CENTER|PC3130231|PC INSULIN, TOTAL|LABORATORY - CHEMISTRY [0301]|83525|90|PC STANDARD FEE SCHEDULE|79.00 PEMBINA COUNTY MEDICAL CENTER|PC3130234|PC IRON|LABORATORY - CHEMISTRY [0301]|83540|90|PC STANDARD FEE SCHEDULE|45.00 PEMBINA COUNTY MEDICAL CENTER|PC3130237|PC IRON BUILDING CAPACITY|LABORATORY - CHEMISTRY [0301]|83550|90|PC STANDARD FEE SCHEDULE|60.00 PEMBINA COUNTY MEDICAL CENTER|PC3130239|PC KETOGENIC STEROIDS FRAC|LABORATORY - CHEMISTRY [0301]|83582|90|PC STANDARD FEE SCHEDULE|96.00 PEMBINA COUNTY MEDICAL CENTER|PC3130240|PC KETOSTEROIDS, 17, TOTAL|LABORATORY - CHEMISTRY [0301]|83586|90|PC STANDARD FEE SCHEDULE|88.00 PEMBINA COUNTY MEDICAL CENTER|PC3130242|PC LACTIC ACID|LABORATORY - CHEMISTRY [0301]|83605|90|PC STANDARD FEE SCHEDULE|73.00 PEMBINA COUNTY MEDICAL CENTER|PC3130247|PC LDH ISO ENZYMES|LABORATORY - CHEMISTRY [0301]|83625|90|PC STANDARD FEE SCHEDULE|88.00 PEMBINA COUNTY MEDICAL CENTER|PC3130249|PC LEAD|LABORATORY - CHEMISTRY [0301]|83655|90|PC STANDARD FEE SCHEDULE|128.00 PEMBINA COUNTY MEDICAL CENTER|PC3130252|PC ENCEPHALITIS, WESTERN EQU|LABORATORY - IMMUNOLOGY [0302]|86654|90|PC STANDARD FEE SCHEDULE|90.00 PEMBINA COUNTY MEDICAL CENTER|PC3130254|PC FLOW CYTOMETRY 1ST MARKER|LABORATORY PATHOLOGICAL - CYTOLOGY [0311]|88184|90|PC STANDARD FEE SCHEDULE|100.00 PEMBINA COUNTY MEDICAL CENTER|PC3130256|PC FLOW CYTOMETRY ADD'L MARK|LABORATORY PATHOLOGICAL - CYTOLOGY [0311]|88185|90|PC STANDARD FEE SCHEDULE|90.00 PEMBINA COUNTY MEDICAL CENTER|PC3130257|PC LIPOPROTEIN DIR MEAS HDLC|LABORATORY - CHEMISTRY [0301]|83718|90|PC STANDARD FEE SCHEDULE|49.00 PEMBINA COUNTY MEDICAL CENTER|PC3130264|PC METANEPHRINES|LABORATORY - CHEMISTRY [0301]|83835|90|PC STANDARD FEE SCHEDULE|237.00 PEMBINA COUNTY MEDICAL CENTER|PC3130270|PC NEPHELOMETRY NES|LABORATORY - CHEMISTRY [0301]|83883|90|PC STANDARD FEE SCHEDULE|233.00 PEMBINA COUNTY MEDICAL CENTER|PC3130272|PC OSMOLITY BLOOD|LABORATORY - CHEMISTRY [0301]|83930|90|PC STANDARD FEE SCHEDULE|46.00 PEMBINA COUNTY MEDICAL CENTER|PC3130275|PC OSMOLITY, URINE|LABORATORY - CHEMISTRY [0301]|83935|90|PC STANDARD FEE SCHEDULE|47.00 PEMBINA COUNTY MEDICAL CENTER|PC3130278|PC PARATHYROID HORMONE|LABORATORY - CHEMISTRY [0301]|83970|90|PC STANDARD FEE SCHEDULE|279.00 PEMBINA COUNTY MEDICAL CENTER|PC3130281|PC PKU|LABORATORY - CHEMISTRY [0301]|84030|90|PC STANDARD FEE SCHEDULE|38.00 PEMBINA COUNTY MEDICAL CENTER|PC3130283|PC PHOSPHATASE ACID TOTAL|LABORATORY - CHEMISTRY [0301]|84060|90|PC STANDARD FEE SCHEDULE|51.00 PEMBINA COUNTY MEDICAL CENTER|PC3130288|PC PHOSPHATASE, ALK ISO|LABORATORY - CHEMISTRY [0301]|84080|90|PC STANDARD FEE SCHEDULE|111.00 PEMBINA COUNTY MEDICAL CENTER|PC3130292|PC PHOSPHORUS, URINE|LABORATORY - CHEMISTRY [0301]|84105|90|PC STANDARD FEE SCHEDULE|36.00 PEMBINA COUNTY MEDICAL CENTER|PC3130297|PC PORPHYRINS QUAN/FRAC|LABORATORY - CHEMISTRY [0301]|84120|90|PC STANDARD FEE SCHEDULE|101.00 PEMBINA COUNTY MEDICAL CENTER|PC3130301|PC POTASSIUM URINE|LABORATORY - CHEMISTRY [0301]|84133|90|PC STANDARD FEE SCHEDULE|29.00 PEMBINA COUNTY MEDICAL CENTER|PC3130303|PC PROGESTERONE|LABORATORY - CHEMISTRY [0301]|84144|90|PC STANDARD FEE SCHEDULE|141.00 PEMBINA COUNTY MEDICAL CENTER|PC3130306|PC PROLACTIN|LABORATORY - CHEMISTRY [0301]|84146|90|PC STANDARD FEE SCHEDULE|131.00 PEMBINA COUNTY MEDICAL CENTER|PC3130317|PC PROTEIN ELECTRO, SERUM|LABORATORY - CHEMISTRY [0301]|84165|90|PC STANDARD FEE SCHEDULE|135.00 PEMBINA COUNTY MEDICAL CENTER|PC3130318|PC PROTEIN ELECTRO, URINE|LABORATORY - CHEMISTRY [0301]|84166|90|PC STANDARD FEE SCHEDULE|122.00 PEMBINA COUNTY MEDICAL CENTER|PC3130320|PC RENIN|LABORATORY - CHEMISTRY [0301]|84244|90|PC STANDARD FEE SCHEDULE|245.00 PEMBINA COUNTY MEDICAL CENTER|PC3130324|PC SODIUM URINE|LABORATORY - CHEMISTRY [0301]|84300|90|PC STANDARD FEE SCHEDULE|34.00 PEMBINA COUNTY MEDICAL CENTER|PC3130326|PC SPEC GRAVITY NOT URINE|LABORATORY - CHEMISTRY [0301]|84315|90|PC STANDARD FEE SCHEDULE|17.00 PEMBINA COUNTY MEDICAL CENTER|PC3130327|PC T-3; FREE|LABORATORY - CHEMISTRY [0301]|84481|90|PC STANDARD FEE SCHEDULE|115.00 PEMBINA COUNTY MEDICAL CENTER|PC3130329|PC TESTOSTERONE FREE|LABORATORY - CHEMISTRY [0301]|84402|90|PC STANDARD FEE SCHEDULE|183.00 PEMBINA COUNTY MEDICAL CENTER|PC3130332|PC TESTOSTERONE TOTAL|LABORATORY - CHEMISTRY [0301]|84403|90|PC STANDARD FEE SCHEDULE|259.00 PEMBINA COUNTY MEDICAL CENTER|PC3130334|PC THYROGLOBULIN|LABORATORY - CHEMISTRY [0301]|84432|90|PC STANDARD FEE SCHEDULE|138.00 PEMBINA COUNTY MEDICAL CENTER|PC3130336|PC T-4/THYROXIN, TOTAL|LABORATORY - CHEMISTRY [0301]|84436|90|PC STANDARD FEE SCHEDULE|84.00 PEMBINA COUNTY MEDICAL CENTER|PC3130339|PC THYROXIN, FREE/ T-4|LABORATORY - CHEMISTRY [0301]|84439|90|PC STANDARD FEE SCHEDULE|56.00 PEMBINA COUNTY MEDICAL CENTER|PC3130340|PC CALCIUM; IONIZED|LABORATORY - CHEMISTRY [0301]|82330|90|PC STANDARD FEE SCHEDULE|92.00 PEMBINA COUNTY MEDICAL CENTER|PC3130341|PC URIC ACID; OTHER SOURCE|LABORATORY - CHEMISTRY [0301]|84560|90|PC STANDARD FEE SCHEDULE|34.00 PEMBINA COUNTY MEDICAL CENTER|PC3130343|PC TACROLIMUS|LABORATORY - CHEMISTRY [0301]|80197|90|PC STANDARD FEE SCHEDULE|93.00 PEMBINA COUNTY MEDICAL CENTER|PC3130344|PC VITAMIN E - LAB|LABORATORY - CHEMISTRY [0301]|84446|90|PC STANDARD FEE SCHEDULE|96.00 PEMBINA COUNTY MEDICAL CENTER|PC3130345|PC LIPOPROTEIN ELECTROPHORES|LABORATORY - CHEMISTRY [0301]|83700|90|PC STANDARD FEE SCHEDULE|49.00 PEMBINA COUNTY MEDICAL CENTER|PC3130347|PC PSA; FREE|LABORATORY - CHEMISTRY [0301]|84154|90|PC STANDARD FEE SCHEDULE|164.00 PEMBINA COUNTY MEDICAL CENTER|PC3130349|PC PROTEIN TOTAL; URINE|LABORATORY - CHEMISTRY [0301]|84156|90|PC STANDARD FEE SCHEDULE|26.00 PEMBINA COUNTY MEDICAL CENTER|PC3130351|PC PHOSPHORUS|LABORATORY - CHEMISTRY [0301]|84100|90|PC STANDARD FEE SCHEDULE|34.00 PEMBINA COUNTY MEDICAL CENTER|PC3130352|PC TRANSFERRIN|LABORATORY - CHEMISTRY [0301]|84466|90|PC STANDARD FEE SCHEDULE|88.00 PEMBINA COUNTY MEDICAL CENTER|PC3130354|PC THYROID HORMONE/T3|LABORATORY - CHEMISTRY [0301]|84479|90|PC STANDARD FEE SCHEDULE|45.00 PEMBINA COUNTY MEDICAL CENTER|PC3130355|PC T-3 TOTAL|LABORATORY - CHEMISTRY [0301]|84480|90|PC STANDARD FEE SCHEDULE|179.00 PEMBINA COUNTY MEDICAL CENTER|PC3130360|PC VMA|LABORATORY - CHEMISTRY [0301]|84585|90|PC STANDARD FEE SCHEDULE|105.00 PEMBINA COUNTY MEDICAL CENTER|PC3130361|PC VASOPRESSIN (ADH)|LABORATORY - CHEMISTRY [0301]|84588|90|PC STANDARD FEE SCHEDULE|228.00 PEMBINA COUNTY MEDICAL CENTER|PC3130362|PC ZINC|LABORATORY - CHEMISTRY [0301]|84630|90|PC STANDARD FEE SCHEDULE|161.00 PEMBINA COUNTY MEDICAL CENTER|PC3130363|PC C-PEPTIDE|LABORATORY - CHEMISTRY [0301]|84681|90|PC STANDARD FEE SCHEDULE|204.00 PEMBINA COUNTY MEDICAL CENTER|PC3130364|PC HCG-QUANTITIVE|LABORATORY - CHEMISTRY [0301]|84702|90|PC STANDARD FEE SCHEDULE|103.00 PEMBINA COUNTY MEDICAL CENTER|PC3130366|PC LEUKOCYTE ALK PHOS|LABORATORY - HEMATOLOGY [0305]|85540|90|PC STANDARD FEE SCHEDULE|59.00 PEMBINA COUNTY MEDICAL CENTER|PC3130369|PC ANA SCREEN|LABORATORY - IMMUNOLOGY [0302]|86038|90|PC STANDARD FEE SCHEDULE|82.00 PEMBINA COUNTY MEDICAL CENTER|PC3130370|PC ASO TITER|LABORATORY - IMMUNOLOGY [0302]|86060|90|PC STANDARD FEE SCHEDULE|95.00 PEMBINA COUNTY MEDICAL CENTER|PC3130371|PC ASO SCREEN|LABORATORY - IMMUNOLOGY [0302]|86063|90|PC STANDARD FEE SCHEDULE|39.00 PEMBINA COUNTY MEDICAL CENTER|PC3130373|PC COLD AGGLUTININS, TITER|LABORATORY - IMMUNOLOGY [0302]|86157|90|PC STANDARD FEE SCHEDULE|83.00 PEMBINA COUNTY MEDICAL CENTER|PC3130375|PC COMPLIMENT ANTIGEN, EACH|LABORATORY - IMMUNOLOGY [0302]|86160|90|PC STANDARD FEE SCHEDULE|183.00 PEMBINA COUNTY MEDICAL CENTER|PC3130376|PC ANTIDNA DOUBLE STRAND|LABORATORY - IMMUNOLOGY [0302]|86225|90|PC STANDARD FEE SCHEDULE|150.00 PEMBINA COUNTY MEDICAL CENTER|PC3130377|PC EXTRACT NUC ANTGN EA ADD'|LABORATORY - GENERAL CLASSIFICATION [0300]|86235|90|PC STANDARD FEE SCHEDULE|123.00 PEMBINA COUNTY MEDICAL CENTER|PC3130378|PC FLUORESCENT AB SCREEN|LABORATORY - IMMUNOLOGY [0302]|86255|90|PC STANDARD FEE SCHEDULE|432.00 PEMBINA COUNTY MEDICAL CENTER|PC3130379|PC CRYSTAL IDENTIFICATION|LABORATORY - OTHER LABORATORY [0309]|89060|90|PC STANDARD FEE SCHEDULE|49.00 PEMBINA COUNTY MEDICAL CENTER|PC3130380|PC FLUORESCENT AB TITER|LABORATORY - IMMUNOLOGY [0302]|86256|90|PC STANDARD FEE SCHEDULE|82.00 PEMBINA COUNTY MEDICAL CENTER|PC3130382|PC IMMUNO TUMOR ANTIGEN/CA12|LABORATORY - IMMUNOLOGY [0302]|86316|90|PC STANDARD FEE SCHEDULE|141.00 PEMBINA COUNTY MEDICAL CENTER|PC3130383|PC HEP C, AMPLIFIED PROBE|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87521|90|PC STANDARD FEE SCHEDULE|238.00 PEMBINA COUNTY MEDICAL CENTER|PC3130385|PC IMMUNOELECTRO, SERUM|LABORATORY - IMMUNOLOGY [0302]|86320|90|PC STANDARD FEE SCHEDULE|152.00 PEMBINA COUNTY MEDICAL CENTER|PC3130386|PC IMMUNOFIXATION ELECTRO|LABORATORY - IMMUNOLOGY [0302]|86334|90|PC STANDARD FEE SCHEDULE|194.00 PEMBINA COUNTY MEDICAL CENTER|PC3130387|PC INSULIN ANTIBODIES|LABORATORY - IMMUNOLOGY [0302]|86337|90|PC STANDARD FEE SCHEDULE|146.00 PEMBINA COUNTY MEDICAL CENTER|PC3130388|PC ISLET CELL ANTIBODY (GLAD|LABORATORY - CHEMISTRY [0301]|86341|90|PC STANDARD FEE SCHEDULE|134.00 PEMBINA COUNTY MEDICAL CENTER|PC3130389|PC MICROSOMAL ANTIBODIES EA|LABORATORY - IMMUNOLOGY [0302]|86376|90|PC STANDARD FEE SCHEDULE|173.00 PEMBINA COUNTY MEDICAL CENTER|PC3130391|PC RA FACTOR QUALITIVE|LABORATORY - IMMUNOLOGY [0302]|86430|90|PC STANDARD FEE SCHEDULE|69.00 PEMBINA COUNTY MEDICAL CENTER|PC3130392|PC SYPHILIS TEST QUALITIVE|LABORATORY - IMMUNOLOGY [0302]|86592|90|PC STANDARD FEE SCHEDULE|29.00 PEMBINA COUNTY MEDICAL CENTER|PC3130393|PC ANTIBODY CMV|LABORATORY - IMMUNOLOGY [0302]|86644|90|PC STANDARD FEE SCHEDULE|97.00 PEMBINA COUNTY MEDICAL CENTER|PC3130394|PC ANTIBODY EBV NUCLEAR|LABORATORY - IMMUNOLOGY [0302]|86664|90|PC STANDARD FEE SCHEDULE|97.00 PEMBINA COUNTY MEDICAL CENTER|PC3130398|PC ANTIBODY HTLV-I|LABORATORY - IMMUNOLOGY [0302]|86687|90|PC STANDARD FEE SCHEDULE|58.00 PEMBINA COUNTY MEDICAL CENTER|PC3130399|PC ANTIBDY HTLV/HIV CONFIRM|LABORATORY - IMMUNOLOGY [0302]|86689|90|PC STANDARD FEE SCHEDULE|369.00 PEMBINA COUNTY MEDICAL CENTER|PC3130400|PC HIV|LABORATORY - CHEMISTRY [0301]|86701|90|PC STANDARD FEE SCHEDULE|60.00 PEMBINA COUNTY MEDICAL CENTER|PC3130401|PC ANTIBODY HIV-1 & 2 SINGLE|LABORATORY - IMMUNOLOGY [0302]|86703|90|PC STANDARD FEE SCHEDULE|68.00 PEMBINA COUNTY MEDICAL CENTER|PC3130402|PC HEPATITIS B SUR ANTIBODY|LABORATORY - IMMUNOLOGY [0302]|86706|90|PC STANDARD FEE SCHEDULE|95.00 PEMBINA COUNTY MEDICAL CENTER|PC3130404|PC INF AGNT HEP B SURF ANTGN|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87340|90|PC STANDARD FEE SCHEDULE|95.00 PEMBINA COUNTY MEDICAL CENTER|PC3130405|PC ANTIBODY LEGIONELLA|LABORATORY - IMMUNOLOGY [0302]|86713|90|PC STANDARD FEE SCHEDULE|97.00 PEMBINA COUNTY MEDICAL CENTER|PC3130406|PC MMR TITER|LABORATORY - CHEMISTRY [0301]|86735|90|PC STANDARD FEE SCHEDULE|89.00 PEMBINA COUNTY MEDICAL CENTER|PC3130407|PC ANTIBODY MYCOPLASMA|LABORATORY - IMMUNOLOGY [0302]|86738|90|PC STANDARD FEE SCHEDULE|90.00 PEMBINA COUNTY MEDICAL CENTER|PC3130409|PC ANTIBODY RUBELLA|LABORATORY - IMMUNOLOGY [0302]|86762|90|PC STANDARD FEE SCHEDULE|130.00 PEMBINA COUNTY MEDICAL CENTER|PC3130410|PC THYROGLOBULIN ANTIBODY|LABORATORY - IMMUNOLOGY [0302]|86800|90|PC STANDARD FEE SCHEDULE|178.00 PEMBINA COUNTY MEDICAL CENTER|PC3130411|PC HEPATITIS C ANTIBODY|LABORATORY - IMMUNOLOGY [0302]|86803|90|PC STANDARD FEE SCHEDULE|116.00 PEMBINA COUNTY MEDICAL CENTER|PC3130418|PC RETICULOCYTE COUNT,AUTO|LABORATORY - CHEMISTRY [0301]|85045|90|PC STANDARD FEE SCHEDULE|38.00 PEMBINA COUNTY MEDICAL CENTER|PC3130420|PC D-DIMER SEMIQUANT|LABORATORY - CHEMISTRY [0301]|85378|90|PC STANDARD FEE SCHEDULE|49.00 PEMBINA COUNTY MEDICAL CENTER|PC3130423|PC THROMBIN TIME, PLASMA|LABORATORY - CHEMISTRY [0301]|85670|90|PC STANDARD FEE SCHEDULE|39.00 PEMBINA COUNTY MEDICAL CENTER|PC3130424|PC CELL COUNT FLUID/DIFF|LABORATORY - CHEMISTRY [0301]|89051|90|PC STANDARD FEE SCHEDULE|37.00 PEMBINA COUNTY MEDICAL CENTER|PC3130429|PC CHLAMYDIA;AMPL PROBE TECH|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87491|90|PC STANDARD FEE SCHEDULE|155.00 PEMBINA COUNTY MEDICAL CENTER|PC3130430|PC N. GONORRHOEAE;AMPLIF PR|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87591|90|PC STANDARD FEE SCHEDULE|155.00 PEMBINA COUNTY MEDICAL CENTER|PC3130431|PC BLOOD SMEAR, PERIPH,BY DR|LABORATORY - HEMATOLOGY [0305]|85060|90|PC STANDARD FEE SCHEDULE|62.00 PEMBINA COUNTY MEDICAL CENTER|PC3130432|PC T CELLS; TOTAL COUNT|LABORATORY - IMMUNOLOGY [0302]|86359|90|PC STANDARD FEE SCHEDULE|255.00 PEMBINA COUNTY MEDICAL CENTER|PC3130433|PC T CELLS;ABSOLUTE CD4 & CD|LABORATORY - IMMUNOLOGY [0302]|86360|90|PC STANDARD FEE SCHEDULE|318.00 PEMBINA COUNTY MEDICAL CENTER|PC3130435|PC MICROALBUMIN (24 HR UR)|LABORATORY - CHEMISTRY [0301]|82043|90|PC STANDARD FEE SCHEDULE|39.00 PEMBINA COUNTY MEDICAL CENTER|PC3130441|PC ROTAVIRUS|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87425|90|PC STANDARD FEE SCHEDULE|78.00 PEMBINA COUNTY MEDICAL CENTER|PC3130442|PC HEPARIN ASSAY/ANTI XA|LABORATORY - CHEMISTRY [0301]|85520|90|PC STANDARD FEE SCHEDULE|264.00 PEMBINA COUNTY MEDICAL CENTER|PC3130443|PC CITRATE|LABORATORY - CHEMISTRY [0301]|82507|90|PC STANDARD FEE SCHEDULE|188.00 PEMBINA COUNTY MEDICAL CENTER|PC3130444|PC OXALATE|LABORATORY - CHEMISTRY [0301]|83945|90|PC STANDARD FEE SCHEDULE|88.00 PEMBINA COUNTY MEDICAL CENTER|PC3130446|PC WBC ANTIBODY ID|LABORATORY - IMMUNOLOGY [0302]|86021|90|PC STANDARD FEE SCHEDULE|102.00 PEMBINA COUNTY MEDICAL CENTER|PC3130453|PC PAROVIRUS ANTIBODY|LABORATORY - IMMUNOLOGY [0302]|86747|90|PC STANDARD FEE SCHEDULE|103.00 PEMBINA COUNTY MEDICAL CENTER|PC3130454|PC RUSSEL VIPER VENOM,DILUTE|LABORATORY - HEMATOLOGY [0305]|85613|90|PC STANDARD FEE SCHEDULE|66.00 PEMBINA COUNTY MEDICAL CENTER|PC3130455|PC D-DIMER QUANT|LABORATORY - CHEMISTRY [0301]|85379|90|PC STANDARD FEE SCHEDULE|149.00 PEMBINA COUNTY MEDICAL CENTER|PC3130456|PC PROTEIN C ANTIGEN|LABORATORY - CHEMISTRY [0301]|85302|90|PC STANDARD FEE SCHEDULE|82.00 PEMBINA COUNTY MEDICAL CENTER|PC3130457|PC A-III ANTIGEN|LABORATORY - CHEMISTRY [0301]|85301|90|PC STANDARD FEE SCHEDULE|74.00 PEMBINA COUNTY MEDICAL CENTER|PC3130458|PC FIBRIN PLASMINOLGEN|LABORATORY - HEMATOLOGY [0305]|85420|90|PC STANDARD FEE SCHEDULE|45.00 PEMBINA COUNTY MEDICAL CENTER|PC3130459|PC PROTEIN C, ACTIVITY|LABORATORY - CHEMISTRY [0301]|85303|90|PC STANDARD FEE SCHEDULE|198.00 PEMBINA COUNTY MEDICAL CENTER|PC3130460|PC HEP B CORE ANTIBODY;TOTAL|LABORATORY - IMMUNOLOGY [0302]|86704|90|PC STANDARD FEE SCHEDULE|111.00 PEMBINA COUNTY MEDICAL CENTER|PC3130461|PC HEP B IgM ANTIBODY|LABORATORY - IMMUNOLOGY [0302]|86705|90|PC STANDARD FEE SCHEDULE|184.00 PEMBINA COUNTY MEDICAL CENTER|PC3130462|PC HEP A IgM ANTIBODY|LABORATORY - IMMUNOLOGY [0302]|86709|90|PC STANDARD FEE SCHEDULE|79.00 PEMBINA COUNTY MEDICAL CENTER|PC3130464|PC HEP B SURFACE ANTIGEN|LABORATORY - IMMUNOLOGY [0302]|87340|90|PC STANDARD FEE SCHEDULE|100.00 PEMBINA COUNTY MEDICAL CENTER|PC3130465|PC ARSENIC|LABORATORY - CHEMISTRY [0301]|82175|90|PC STANDARD FEE SCHEDULE|136.00 PEMBINA COUNTY MEDICAL CENTER|PC3130466|PC CADMIUM|LABORATORY - CHEMISTRY [0301]|82300|90|PC STANDARD FEE SCHEDULE|157.00 PEMBINA COUNTY MEDICAL CENTER|PC3130467|PC MERCURY, QUANTITIVE|LABORATORY - CHEMISTRY [0301]|83825|90|PC STANDARD FEE SCHEDULE|135.00 PEMBINA COUNTY MEDICAL CENTER|PC3130468|PC ANTITHROMBIN III TEST|LABORATORY - CHEMISTRY [0301]|85300|90|PC STANDARD FEE SCHEDULE|173.00 PEMBINA COUNTY MEDICAL CENTER|PC3130469|PC PROTEIN S, FREE|LABORATORY - CHEMISTRY [0301]|85306|90|PC STANDARD FEE SCHEDULE|221.00 PEMBINA COUNTY MEDICAL CENTER|PC3130470|PC CARDIOLIPIN ANTIBODY|LABORATORY - IMMUNOLOGY [0302]|86147|90|PC STANDARD FEE SCHEDULE|166.00 PEMBINA COUNTY MEDICAL CENTER|PC3130471|PC PLASMA FRACTIONS|LABORATORY - HEMATOLOGY [0305]|85611|90|PC STANDARD FEE SCHEDULE|28.00 PEMBINA COUNTY MEDICAL CENTER|PC3130472|PC THROMBOPLASTIN TIME,PARTI|LABORATORY - CHEMISTRY [0301]|85732|90|PC STANDARD FEE SCHEDULE|45.00 PEMBINA COUNTY MEDICAL CENTER|PC3130473|PC CLINIC PATH CONSULT, LIMI|LABORATORY - CHEMISTRY [0301]|80500|90|PC STANDARD FEE SCHEDULE|8.00 PEMBINA COUNTY MEDICAL CENTER|PC3130474|PC TOPIRAMATE|LABORATORY - CHEMISTRY [0301]|80201|90|PC STANDARD FEE SCHEDULE|81.00 PEMBINA COUNTY MEDICAL CENTER|PC3130480|PC CERULOPLASMIN|LABORATORY - CHEMISTRY [0301]|82390|90|PC STANDARD FEE SCHEDULE|135.00 PEMBINA COUNTY MEDICAL CENTER|PC3130481|PC ACTIVATED PROTEIN C (APC)|LABORATORY - CHEMISTRY [0301]|85307|90|PC STANDARD FEE SCHEDULE|222.00 PEMBINA COUNTY MEDICAL CENTER|PC3130482|PC CLOTTING: FACTOR V.|LABORATORY - CHEMISTRY [0301]|85220|90|PC STANDARD FEE SCHEDULE|119.00 PEMBINA COUNTY MEDICAL CENTER|PC3130484|PC IMMUNOASSAY TUMOR CA 125|LABORATORY - IMMUNOLOGY [0302]|86304|90|PC STANDARD FEE SCHEDULE|141.00 PEMBINA COUNTY MEDICAL CENTER|PC3130485|PC CCP ANTIBODY|LABORATORY - IMMUNOLOGY [0302]|86200|90|PC STANDARD FEE SCHEDULE|185.00 PEMBINA COUNTY MEDICAL CENTER|PC3130486|PC BETA 2 GLYCOPROTEIN 1 ANT|LABORATORY - IMMUNOLOGY [0302]|86146|90|PC STANDARD FEE SCHEDULE|184.00 PEMBINA COUNTY MEDICAL CENTER|PC3130488|PC REPTILASE TEST|LABORATORY - IMMUNOLOGY [0302]|85635|90|PC STANDARD FEE SCHEDULE|68.00 PEMBINA COUNTY MEDICAL CENTER|PC3130489|PC FACTOR VII|LABORATORY - IMMUNOLOGY [0302]|85230|90|PC STANDARD FEE SCHEDULE|123.00 PEMBINA COUNTY MEDICAL CENTER|PC3130490|PC CULTURE, IMMUNOLOGIC METH|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87147|90|PC STANDARD FEE SCHEDULE|36.00 PEMBINA COUNTY MEDICAL CENTER|PC3130491|PC HOMOCYSTINE|LABORATORY - CHEMISTRY [0301]|83090|90|PC STANDARD FEE SCHEDULE|324.00 PEMBINA COUNTY MEDICAL CENTER|PC3130493|PC QUANT OF DRUG, NOT ELSEWH|LABORATORY - CHEMISTRY [0301]|80299|90|PC STANDARD FEE SCHEDULE|93.00 PEMBINA COUNTY MEDICAL CENTER|PC3130494|PC CYTOMEGALOVIRUS,AMPL PROB|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87496|90|PC STANDARD FEE SCHEDULE|238.00 PEMBINA COUNTY MEDICAL CENTER|PC3130495|PC T3;REVERSE|LABORATORY - CHEMISTRY [0301]|84482|90|PC STANDARD FEE SCHEDULE|315.00 PEMBINA COUNTY MEDICAL CENTER|PC3130496|PC ALDOLASE|LABORATORY - CHEMISTRY [0301]|82085|90|PC STANDARD FEE SCHEDULE|67.00 PEMBINA COUNTY MEDICAL CENTER|PC3130497|PC ANAEROBIC ID|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87076|90|PC STANDARD FEE SCHEDULE|56.00 PEMBINA COUNTY MEDICAL CENTER|PC3130498|PC FACTOR II|LABORATORY - IMMUNOLOGY [0302]|85210|90|PC STANDARD FEE SCHEDULE|89.00 PEMBINA COUNTY MEDICAL CENTER|PC3130499|PC FACTOR V|LABORATORY - IMMUNOLOGY [0302]|85220|90|PC STANDARD FEE SCHEDULE|119.00 PEMBINA COUNTY MEDICAL CENTER|PC3130500|PC IGF (SOMA - C)|LABORATORY - CHEMISTRY [0301]|84305|90|PC STANDARD FEE SCHEDULE|134.00 PEMBINA COUNTY MEDICAL CENTER|PC3130501|PC PROTEIN: ELECTRO URINE|LABORATORY - CHEMISTRY [0301]|84166|90|PC STANDARD FEE SCHEDULE|122.00 PEMBINA COUNTY MEDICAL CENTER|PC3130502|PC IMMUNO E-PHORESIS/URINE|LABORATORY - IMMUNOLOGY [0302]|86335|90|PC STANDARD FEE SCHEDULE|198.00 PEMBINA COUNTY MEDICAL CENTER|PC3130503|PC COMPLEMENT, FUNCTIONAL|LABORATORY - IMMUNOLOGY [0302]|86161|90|PC STANDARD FEE SCHEDULE|82.00 PEMBINA COUNTY MEDICAL CENTER|PC3130510|PC HEP B ANTIBODY|LABORATORY - IMMUNOLOGY [0302]|86707|90|PC STANDARD FEE SCHEDULE|105.00 PEMBINA COUNTY MEDICAL CENTER|PC3130522|PC PT / I & R, COED CONSULT|LABORATORY - HEMATOLOGY [0305]|85610|90|PC STANDARD FEE SCHEDULE|28.00 PEMBINA COUNTY MEDICAL CENTER|PC3130537|PC FAT OR LIPIDS;FECES|LABORATORY - CHEMISTRY [0301]|82710|90|PC STANDARD FEE SCHEDULE|114.00 PEMBINA COUNTY MEDICAL CENTER|PC3130540|PC B-6|LABORATORY - CHEMISTRY [0301]|84207|90|PC STANDARD FEE SCHEDULE|192.00 PEMBINA COUNTY MEDICAL CENTER|PC3130541|PC RIBOFLAVIN, B-2|LABORATORY - CHEMISTRY [0301]|84252|90|PC STANDARD FEE SCHEDULE|137.00 PEMBINA COUNTY MEDICAL CENTER|PC3130617|PC BORRELIA (LYME) CONFIRMAT|LABORATORY - IMMUNOLOGY [0302]|86617|90|PC STANDARD FEE SCHEDULE|176.00 PEMBINA COUNTY MEDICAL CENTER|PC3130802|PC CULTURE, IMMUNOLOGIC METH|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87147|90|PC STANDARD FEE SCHEDULE|36.00 PEMBINA COUNTY MEDICAL CENTER|PC3130805|PC C-REACT PROTEIN;HIGH SENS|LABORATORY - GENERAL CLASSIFICATION [0300]|86141|90|PC STANDARD FEE SCHEDULE|89.00 PEMBINA COUNTY MEDICAL CENTER|PC3130807|PC WBC SMEAR STOOL|LABORATORY - GENERAL CLASSIFICATION [0300]|89055|90|PC STANDARD FEE SCHEDULE|29.00 PEMBINA COUNTY MEDICAL CENTER|PC3130809|PC HISTOPLASMA CAPSULATUM|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87385|90|PC STANDARD FEE SCHEDULE|82.00 PEMBINA COUNTY MEDICAL CENTER|PC3130811|PC GIARDIA ASSAY|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87329|90|PC STANDARD FEE SCHEDULE|82.00 PEMBINA COUNTY MEDICAL CENTER|PC3130812|PC MRSA BY PCR|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87641|90|PC STANDARD FEE SCHEDULE|238.00 PEMBINA COUNTY MEDICAL CENTER|PC3130813|PC GRP B STREP|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87653|90|PC STANDARD FEE SCHEDULE|238.00 PEMBINA COUNTY MEDICAL CENTER|PC3130814|PC COPPER|LABORATORY - CHEMISTRY [0301]|82525|90|PC STANDARD FEE SCHEDULE|144.00 PEMBINA COUNTY MEDICAL CENTER|PC3130815|PC COOMBS, INDIRECT, EA TITE|LABORATORY - IMMUNOLOGY [0302]|86886|90|PC STANDARD FEE SCHEDULE|36.00 PEMBINA COUNTY MEDICAL CENTER|PC3130816|PC ORGANIC ACID (MMA)|LABORATORY - CHEMISTRY [0301]|83921|90|PC STANDARD FEE SCHEDULE|380.00 PEMBINA COUNTY MEDICAL CENTER|PC3130818|PC INHIBIN A|LABORATORY - IMMUNOLOGY [0302]|86336|90|PC STANDARD FEE SCHEDULE|89.00 PEMBINA COUNTY MEDICAL CENTER|PC3130819|PC EHRLICHA CHAFFENIS|LABORATORY - IMMUNOLOGY [0302]|86666|90|PC STANDARD FEE SCHEDULE|69.00 PEMBINA COUNTY MEDICAL CENTER|PC3130820|PC BABESIA MICROTI|LABORATORY - IMMUNOLOGY [0302]|86720|90|PC STANDARD FEE SCHEDULE|90.00 PEMBINA COUNTY MEDICAL CENTER|PC3130821|PC LEPTOSPIRA ANTIBODY|LABORATORY - IMMUNOLOGY [0302]|86720|90|PC STANDARD FEE SCHEDULE|90.00 PEMBINA COUNTY MEDICAL CENTER|PC3131001|PC CA 19-9|LABORATORY - IMMUNOLOGY [0302]|86301|90|PC STANDARD FEE SCHEDULE|141.00 PEMBINA COUNTY MEDICAL CENTER|PC3131002|PC CULTURE-CRYPTOSPORIDIUM|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87328|90|PC STANDARD FEE SCHEDULE|82.00 PEMBINA COUNTY MEDICAL CENTER|PC3140003|PC BLOOD SMEAR, PERIPH,BY DR|LABORATORY - HEMATOLOGY [0305]|85060|90|PC STANDARD FEE SCHEDULE|60.00 PEMBINA COUNTY MEDICAL CENTER|PC3140004|PC PAP SMEAR SCREEN, M.D.|LABORATORY PATHOLOGICAL - CYTOLOGY [0311]|88164|90|PC STANDARD FEE SCHEDULE|72.00 PEMBINA COUNTY MEDICAL CENTER|PC3140006|PC SCREENING CYTOPATHOLOGY|LABORATORY PATHOLOGICAL - CYTOLOGY [0311]|G0123|90|PC STANDARD FEE SCHEDULE|137.00 PEMBINA COUNTY MEDICAL CENTER|PC3140111|PC SMEAR W/ INTERP/NOT PAP|LABORATORY PATHOLOGICAL - CYTOLOGY [0311]|88104|90|PC STANDARD FEE SCHEDULE|107.00 PEMBINA COUNTY MEDICAL CENTER|PC3140302|PC TISSUE EXAM PATHOLOGIST|LABORATORY PATHOLOGICAL - BIOPSY [0314]|88302|90,TC|PC STANDARD FEE SCHEDULE|156.00 PEMBINA COUNTY MEDICAL CENTER|PC3140304|PC TISSUE EXAM PATHOLOGIST|LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION [0310]|88304|90,TC|PC STANDARD FEE SCHEDULE|161.00 PEMBINA COUNTY MEDICAL CENTER|PC3140305|PC TISSUE EXAM PATHOLOGIST|LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION [0310]|88305|90,TC|PC STANDARD FEE SCHEDULE|220.00 PEMBINA COUNTY MEDICAL CENTER|PC3140307|PC TISSUE EXAM PATHOLOGIST|LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION [0310]|88307|90,TC|PC STANDARD FEE SCHEDULE|489.00 PEMBINA COUNTY MEDICAL CENTER|PC3140309|PC TISSUE EXAM PATHOLOGIST|LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION [0310]|88309|90,TC|PC STANDARD FEE SCHEDULE|679.00 PEMBINA COUNTY MEDICAL CENTER|3200319|XRAY FACIAL BONES <3 VW|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|70140||PC STANDARD FEE SCHEDULE|83.00 PEMBINA COUNTY MEDICAL CENTER|4020101|HC US ASP OF OVA|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76948||PC STANDARD FEE SCHEDULE|80.00 PEMBINA COUNTY MEDICAL CENTER|4020102|HC OB US DETAILED,SNGL|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76811||PC STANDARD FEE SCHEDULE|469.00 PEMBINA COUNTY MEDICAL CENTER|4020103|HC OB US DETAILED,EA ADDL|OTHER IMAGING SERVICES - ULTRASOUND [0402]|76812||PC STANDARD FEE SCHEDULE|514.00 PEMBINA COUNTY MEDICAL CENTER|3430032|HC I-123 UP TO 5MCI|NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS [0343]|A9584||PC STANDARD FEE SCHEDULE|340.00 PEMBINA COUNTY MEDICAL CENTER|4300037|HC ROM TEST-TOTAL BODY|OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION [0430]|95833||PC STANDARD FEE SCHEDULE|175.00 PEMBINA COUNTY MEDICAL CENTER|4300038|ROM HAND|OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION [0430]|95852||PC STANDARD FEE SCHEDULE|68.00 PEMBINA COUNTY MEDICAL CENTER|4201000|HC MOBILITY CURRENT STATUS|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|G8978||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4201001|MOBILITY GOAL STATUS|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|G8979||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4201002|MOBILITY D/C STATUS|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|G8980||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4201003|BODY POS CURRENT STATUS|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|G8981||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4201004|BODY POS GOAL STATUS|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|G8982||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4201005|BODY POS D/C STATUS|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|G8983||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4201006|CARRY CURRENT STATUS|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|G8984||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4201007|CARRY GOAL STATUS|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|G8985||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4201008|CARRY D/C STATUS|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|G8986||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4201009|SELF CARE CURRENT STATUS|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|G8987||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4201010|SELF CARE GOAL STATUS|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|G8988||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4201011|SELF CARE D/C STATUS|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|G8989||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4201012|OTHER PT/OT CURRENT STATUS|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|G8990||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4201013|OTHER PT/OT GOAL STATUS|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|G8991||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4201014|OTHER PT/OT D/C STATUS|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|G8992||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4201015|SUB PT/OT CURRENT STATUS|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|G8993||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4201016|SUB PT/OT GOAL STATUS|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|G8994||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4201017|SUB PT/OT D/C STATUS|PHYSICAL THERAPY - GENERAL CLASSIFICATION [0420]|G8995||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4401000|SWALLOW CURRENT STATUS|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|G8996||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4401001|SWALLOW GOAL STATUS|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|G8997||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4401002|SWALLOW D/C STATUS|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|G8998||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4401003|MOTOR SPEECH CURRENT STATUS|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|G8999||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4401004|HC MOTOR SPEECH GOAL STATUS|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|G9186||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4401005|MOTOR SPEECH D/C STATUS|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|G9158||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4401006|LANG COMP CURRENT STATUS|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|G9159||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4401007|LANG COMP GOAL STATUS|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|G9160||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4401008|LANG COMP D/C STATUS|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|G9161||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4401009|LANG EXPRESS CURRENT STATUS|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|G9162||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4401010|LANG EXPRESS GOAL STATUS|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|G9163||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4401011|LANG EXPRESS D/C STATUS|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|G9164||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4401012|ATTN CURRENT STATUS|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|G9165||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4401013|ATTN GOAL STATUS|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|G9166||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4401014|ATTN D/C STATUS|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|G9167||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4401015|MEMORY CURRENT STATUS|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|G9168||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4401016|MEMORY GOAL STATUS|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|G9169||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4401017|MEMORY D/C STATUS|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|G9170||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4401018|VOICE CURRENT STATUS|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|G9171||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4401019|VOICE GOAL STATUS|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|G9172||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4401020|VOICE D/C STATUS|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|G9173||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4401021|SPEECH LANG CURRENT STATUS|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|G9174||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4401022|SPEECH LANG GOAL STATUS|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|G9175||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|4401023|SPEECH LANG D/C STATUS|SPEECH THERAPY - LANGUAGE PATHOLOGY - GENERAL CLASSIFICATION [0440]|G9176||PC STANDARD FEE SCHEDULE|1.00 PEMBINA COUNTY MEDICAL CENTER|PC3380003|PC MNT-15 MINUTES|OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING [0942]|97802||PC STANDARD FEE SCHEDULE|79.00 PEMBINA COUNTY MEDICAL CENTER|PC3380004|PC MNT-RE-ASSESSMENT/15 MIN|OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING [0942]|97803||PC STANDARD FEE SCHEDULE|68.00 PEMBINA COUNTY MEDICAL CENTER|PC3380007|PC MNT-GROUP (2 OR MORE)|OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING [0942]|97804||PC STANDARD FEE SCHEDULE|38.00 PEMBINA COUNTY MEDICAL CENTER|PC3380009|PC MNT-GROUP RE-ASSESS/30 MIN|OTHER THERAPEUTIC SERVICES - EDUCATION/TRAINING [0942]|G0271||PC STANDARD FEE SCHEDULE|38.00 PEMBINA COUNTY MEDICAL CENTER|PCG390L4|PC LEVEL IV TRAUMA|TRAUMA RESPONSE - LEVEL IV TRAUMA [0684]|G0390||PC STANDARD FEE SCHEDULE|141.00 PEMBINA COUNTY MEDICAL CENTER|PC3110008|PC BLOOD ALCOHOL-LAW ENFORCEMENT|EMERGENCY ROOM - GENERAL CLASSIFICATION [0450]|||PC STANDARD FEE SCHEDULE|53.00 PEMBINA COUNTY MEDICAL CENTER|PC3080088|PC YAG LASER SURGERY|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|||PC STANDARD FEE SCHEDULE|855.00 PEMBINA COUNTY MEDICAL CENTER|PC3080001|PC LEVEL 1 SURGERY|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|||PC STANDARD FEE SCHEDULE|1,435.00 PEMBINA COUNTY MEDICAL CENTER|PC3080002|pC LEVEL 2 SURGERY|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|||PC STANDARD FEE SCHEDULE|2,199.00 PEMBINA COUNTY MEDICAL CENTER|PC3080003|pC LEVEL 3 SURGERY|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|||PC STANDARD FEE SCHEDULE|3,518.00 PEMBINA COUNTY MEDICAL CENTER|PC3080004|PC LEVEL 4 SURGERY|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|||PC STANDARD FEE SCHEDULE|5,624.00 PEMBINA COUNTY MEDICAL CENTER|PC3090001|PC RECOVERY CARE (PAR)|RECOVERY ROOM - GENERAL CLASSIFICATION [0710]|||PC STANDARD FEE SCHEDULE|14.00 PEMBINA COUNTY MEDICAL CENTER|PC3090002|PC EXTENDED RECOVERY 1ST HR|RECOVERY ROOM - GENERAL CLASSIFICATION [0710]|||PC STANDARD FEE SCHEDULE|480.00 PEMBINA COUNTY MEDICAL CENTER|PC3090003|PC EXTENDED RECOVERY ADDL HR|RECOVERY ROOM - GENERAL CLASSIFICATION [0710]|||PC STANDARD FEE SCHEDULE|70.00 PEMBINA COUNTY MEDICAL CENTER|PC3150002|PC RBCs; LEUK-REDUCED EA UNT|ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION [0390]|P9016||PC STANDARD FEE SCHEDULE|686.00 PEMBINA COUNTY MEDICAL CENTER|PC3150006|PC TRANSF BLOOD/BLOOD COMPON|ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION [0390]|36430||PC STANDARD FEE SCHEDULE|504.00 PEMBINA COUNTY MEDICAL CENTER|PC3150007|PC PLATELETS;PHERESIS;LEUKOC|ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION [0390]|P9035||PC STANDARD FEE SCHEDULE|1,812.00 PEMBINA COUNTY MEDICAL CENTER|PC3150008|PC FR FRZN PLASMA S/P|ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION [0390]|P9017||PC STANDARD FEE SCHEDULE|275.00 PEMBINA COUNTY MEDICAL CENTER|PC3150012|PC IRRADIATED PRODUCTS|ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION [0390]|86945|90|PC STANDARD FEE SCHEDULE|65.00 PEMBINA COUNTY MEDICAL CENTER|PC3150037|PC PLATLETS; IRRATIATED|ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION [0390]|P9037||PC STANDARD FEE SCHEDULE|2,397.00 PEMBINA COUNTY MEDICAL CENTER|PC3150040|PC RBC S; IRRADIATED|ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION [0390]|P9040||PC STANDARD FEE SCHEDULE|966.00 PEMBINA COUNTY MEDICAL CENTER|PC3120041|PC SUTURES, SIMPLE|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|26.00 PEMBINA COUNTY MEDICAL CENTER|PC3120040|PC SKIN STAPLES 35W|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|76.00 PEMBINA COUNTY MEDICAL CENTER|PC3120046|PC SUPPLIES & MATERIALS PROV|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|99070||PC STANDARD FEE SCHEDULE|176.00 PEMBINA COUNTY MEDICAL CENTER|PC3120027|PC SPLINT METAL|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|A4570||PC STANDARD FEE SCHEDULE|180.00 PEMBINA COUNTY MEDICAL CENTER|PC3120054|PC SPLINT COLLES|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|A4570||PC STANDARD FEE SCHEDULE|44.00 PEMBINA COUNTY MEDICAL CENTER|PC3120335|PC OT ROSIDAL SOFT|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|A6441||PC STANDARD FEE SCHEDULE|15.00 PEMBINA COUNTY MEDICAL CENTER|PC3120336|PC OT STOCINETTE 4" / YD|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|A6443||PC STANDARD FEE SCHEDULE|5.00 PEMBINA COUNTY MEDICAL CENTER|PC3120338|PC OT KT(SUPPLY) 10CM|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|A6452||PC STANDARD FEE SCHEDULE|29.00 PEMBINA COUNTY MEDICAL CENTER|PC3120339|PC OT KT (SUPPLY) 12 CM|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|A6452||PC STANDARD FEE SCHEDULE|35.00 PEMBINA COUNTY MEDICAL CENTER|PC3120340|PC OT KT (SUPPLY) 8 CM|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|A6452||PC STANDARD FEE SCHEDULE|26.00 PEMBINA COUNTY MEDICAL CENTER|PC3120341|PC OT COMPRILAN 8 CM|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|A6452||PC STANDARD FEE SCHEDULE|20.00 PEMBINA COUNTY MEDICAL CENTER|PC3120342|PC OT COMPRILAN 10 CM|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|A6452||PC STANDARD FEE SCHEDULE|26.00 PEMBINA COUNTY MEDICAL CENTER|PC3120343|PC OT COMPRILAN 12 CM|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|A6452||PC STANDARD FEE SCHEDULE|24.00 PEMBINA COUNTY MEDICAL CENTER|PC3120337|PC OT TUBI GRIP G/3 YD|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|A6457||PC STANDARD FEE SCHEDULE|37.00 PEMBINA COUNTY MEDICAL CENTER|PC3120344|PC OT STOCKINETTE 6"|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|A6457||PC STANDARD FEE SCHEDULE|6.00 PEMBINA COUNTY MEDICAL CENTER|PC3120347|PC OT ISOTONER GLOVE|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|A6549||PC STANDARD FEE SCHEDULE|17.00 PEMBINA COUNTY MEDICAL CENTER|PC3120346|PC OT FOAM BLOCKS|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|A9300||PC STANDARD FEE SCHEDULE|6.00 PEMBINA COUNTY MEDICAL CENTER|PC3120447|PC OT BLUE PUTTY|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|A9300||PC STANDARD FEE SCHEDULE|10.00 PEMBINA COUNTY MEDICAL CENTER|PC3120448|PC OT HAND GRIPPERS|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|A9300||PC STANDARD FEE SCHEDULE|28.00 PEMBINA COUNTY MEDICAL CENTER|PC3120450|PC OT THERABAND|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|A9300||PC STANDARD FEE SCHEDULE|10.00 PEMBINA COUNTY MEDICAL CENTER|PC3120449|PC OT MULTILIGAMENT ANKLE SP|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|L1906||PC STANDARD FEE SCHEDULE|261.00 PEMBINA COUNTY MEDICAL CENTER|PC3120036|PC A/C SPLINT DEPUY UNIVERSA|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|L3660||PC STANDARD FEE SCHEDULE|212.00 PEMBINA COUNTY MEDICAL CENTER|PC3120058|PC CLAV/SHOULDER SPLINT/HVY|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|L3660||PC STANDARD FEE SCHEDULE|233.00 PEMBINA COUNTY MEDICAL CENTER|PC3120057|PC ELBOW SPLINT POSTERIOR|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|L3762||PC STANDARD FEE SCHEDULE|76.00 PEMBINA COUNTY MEDICAL CENTER|PC3120053|PC MASON ALLAN SPLINT|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|L3807||PC STANDARD FEE SCHEDULE|123.00 PEMBINA COUNTY MEDICAL CENTER|PC3120056|PC SPEED HAND SPLINT|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|L3807||PC STANDARD FEE SCHEDULE|123.00 PEMBINA COUNTY MEDICAL CENTER|PC3120051|PC THUMB SPICA|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|L3923||PC STANDARD FEE SCHEDULE|61.00 PEMBINA COUNTY MEDICAL CENTER|PC3120052|PC METACARPAL SPLINT|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|L3999||PC STANDARD FEE SCHEDULE|12.00 PEMBINA COUNTY MEDICAL CENTER|PC3120045|PC WALKER BOOT|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|L4386||PC STANDARD FEE SCHEDULE|294.00 PEMBINA COUNTY MEDICAL CENTER|PC3120001|PC ARM SHOULDER IMMOBILIZER|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|91.00 PEMBINA COUNTY MEDICAL CENTER|PC3120002|PC ANKLE BRACE|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|36.00 PEMBINA COUNTY MEDICAL CENTER|PC3120003|PC KNEE IMMOBILIZER|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|107.00 PEMBINA COUNTY MEDICAL CENTER|PC3120004|PC FINGER METAL TIPS|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|4.00 PEMBINA COUNTY MEDICAL CENTER|PC3120005|PC CERVICAL FOAM COLLAR|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|47.00 PEMBINA COUNTY MEDICAL CENTER|PC3120006|PC WRIST SPLINT|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|54.00 PEMBINA COUNTY MEDICAL CENTER|PC3120007|PC FINGER SPLINT, FOAM|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|126.00 PEMBINA COUNTY MEDICAL CENTER|PC3120008|PC PADDED CLAVICLE BRACE|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|53.00 PEMBINA COUNTY MEDICAL CENTER|PC3120011|PC UNIVERSAL ABD BINDER|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|73.00 PEMBINA COUNTY MEDICAL CENTER|PC3120012|PC FREDDIE THE FROG SPL|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|8.00 PEMBINA COUNTY MEDICAL CENTER|PC3120013|PC UNIVERSAL RIB BELT WOMENS|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|39.00 PEMBINA COUNTY MEDICAL CENTER|PC3120014|PC UNIVERSAL RIB BELT MALE|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|32.00 PEMBINA COUNTY MEDICAL CENTER|PC3120015|PC ARM SLING STRAP/CUFF LRG|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|57.00 PEMBINA COUNTY MEDICAL CENTER|PC3120016|PC OPEN THIMBLE SPLINT|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|13.00 PEMBINA COUNTY MEDICAL CENTER|PC3120017|PC RICHARDS AC SPLINT S|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|266.00 PEMBINA COUNTY MEDICAL CENTER|PC3120018|PC RICHARDS AC SPLINT L|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|216.00 PEMBINA COUNTY MEDICAL CENTER|PC3120020|PC ARM SLING STRAP, MEDIUM|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|31.00 PEMBINA COUNTY MEDICAL CENTER|PC3120021|PC CLAVICLE BRACE MEEK|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|57.00 PEMBINA COUNTY MEDICAL CENTER|PC3120022|PC ELASTIC KNEE SUPPORT|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|36.00 PEMBINA COUNTY MEDICAL CENTER|PC3120023|PC DEPUY HEEL/ELBOW PROTECTO|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|39.00 PEMBINA COUNTY MEDICAL CENTER|PC3120025|PC HEELBO|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|39.00 PEMBINA COUNTY MEDICAL CENTER|PC3120026|PC RIGID CERVICAL COLLAR|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|115.00 PEMBINA COUNTY MEDICAL CENTER|PC3120028|PC BURNAM THUMB SPLINT|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|95.00 PEMBINA COUNTY MEDICAL CENTER|PC3120029|PC METAL STRIPS FINGER|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|12.00 PEMBINA COUNTY MEDICAL CENTER|PC3120030|PC METAL STRIPS STYRO|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|12.00 PEMBINA COUNTY MEDICAL CENTER|PC3120031|PC VELFOAM SLING & SWAT|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|69.00 PEMBINA COUNTY MEDICAL CENTER|PC3120033|PC ARM SLING, AMER, LARGE|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|59.00 PEMBINA COUNTY MEDICAL CENTER|PC3120034|PC ARM SLING, AMER, SMALL|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|44.00 PEMBINA COUNTY MEDICAL CENTER|PC3120035|PC WALKING HEEL FOR PLAST|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|26.00 PEMBINA COUNTY MEDICAL CENTER|PC3120037|PC ARM SLING, AMER, MED|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|79.00 PEMBINA COUNTY MEDICAL CENTER|PC3120038|PC WALKING HEEL FOR HEX|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|36.00 PEMBINA COUNTY MEDICAL CENTER|PC3120039|PC UNA BOOT|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|41.00 PEMBINA COUNTY MEDICAL CENTER|PC3120043|PC SACRAL LUMBAR SUPPORT|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|89.00 PEMBINA COUNTY MEDICAL CENTER|PC3120047|PC SURGICAL BOOT/SHOE, EA|MEDICAL/SURGICAL SUPPLIES AND DEVICES - PROSTHETIC/ORTHOTIC DEVICES [0274]|L3260||PC STANDARD FEE SCHEDULE|45.00 PEMBINA COUNTY MEDICAL CENTER|PC3120050|PC ELBOW SPLINT RIGID|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|160.00 PEMBINA COUNTY MEDICAL CENTER|PC3120082|PC GEL SHEET; DERMAL OR EPID|MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY [0272]|A6025||PC STANDARD FEE SCHEDULE|198.00 PEMBINA COUNTY MEDICAL CENTER|PC3120100|PC COMPRILON BANDAGE|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|19.00 PEMBINA COUNTY MEDICAL CENTER|PC3120101|PC CELLONA PADDING|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|8.00 PEMBINA COUNTY MEDICAL CENTER|PC3120102|PC SOFT ROSIDAL|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|15.00 PEMBINA COUNTY MEDICAL CENTER|PC3120103|PC STOCKINETTE|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|10.00 PEMBINA COUNTY MEDICAL CENTER|PC3120104|PC COTTON WRAP|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|10.00 PEMBINA COUNTY MEDICAL CENTER|PC3120151|PC THUMB SPLINT|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|115.00 PEMBINA COUNTY MEDICAL CENTER|PC3120152|PC SPOT ENDOSCOPY MARKER|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|131.00 PEMBINA COUNTY MEDICAL CENTER|PC3120300|PC EYE IRRIGATION SOLUTION|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|45.00 PEMBINA COUNTY MEDICAL CENTER|PC3120301|PC EYE SUTURES|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|89.00 PEMBINA COUNTY MEDICAL CENTER|PC3340002|PC PELVIC TX UNIVERSAL|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|51.00 PEMBINA COUNTY MEDICAL CENTER|PC3340004|PC SPLINT BUCK UNIVERSAL|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|56.00 PEMBINA COUNTY MEDICAL CENTER|PC3340006|PC LUMBOSACRAL SUPPORT UNIVE|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|464.00 PEMBINA COUNTY MEDICAL CENTER|PC3120055|PC INF PUMP, IMPLANT, NONPRO|MEDICAL/SURGICAL SUPPLIES AND DEVICES - NON STERILE SUPPLY [0271]|E0782||PC STANDARD FEE SCHEDULE|1,157.00 PEMBINA COUNTY MEDICAL CENTER|PC3320015|PC IVF DEXTROSE 5% 100ML PF|MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY [0272]|A4216||PC STANDARD FEE SCHEDULE|21.00 PEMBINA COUNTY MEDICAL CENTER|PC3320016|PC IVF-DEXTROSE 5% WATER 250|MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY [0272]|A4216||PC STANDARD FEE SCHEDULE|21.00 PEMBINA COUNTY MEDICAL CENTER|PC3320028|PC D5W 100 ML MINIBAG|MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY [0272]|A4216||PC STANDARD FEE SCHEDULE|21.00 PEMBINA COUNTY MEDICAL CENTER|PC3320029|PC IVF-SODIUM CHLORIDE 0.9%|MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY [0272]|A4216||PC STANDARD FEE SCHEDULE|21.00 PEMBINA COUNTY MEDICAL CENTER|PC3320032|PC D5W 250 ML ADVANTAGE|MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY [0272]|A4216||PC STANDARD FEE SCHEDULE|21.00 PEMBINA COUNTY MEDICAL CENTER|PC3320037|PC D5W 50 ML MINIBAG|MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY [0272]|A4216||PC STANDARD FEE SCHEDULE|21.00 PEMBINA COUNTY MEDICAL CENTER|PC3320039|PC IVF-SODIUM CHLORIDE 0.9%|MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY [0272]|A4216||PC STANDARD FEE SCHEDULE|21.00 PEMBINA COUNTY MEDICAL CENTER|PC3320040|PC IVF-SODIUM CHLORIDE 0.9%|MEDICAL/SURGICAL SUPPLIES AND DEVICES - STERILE SUPPLY [0272]|A4216||PC STANDARD FEE SCHEDULE|21.00 PEMBINA COUNTY MEDICAL CENTER|PC3100077|PC INTRA OCULAR LENS|MEDICAL/SURGICAL SUPPLIES AND DEVICES - INTRAOCULAR LENS [0276]|V2632||PC STANDARD FEE SCHEDULE|350.00 PEMBINA COUNTY MEDICAL CENTER|PC3100060|PC MESH: IMPLANTABLE|MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT [0278]|C1781||PC STANDARD FEE SCHEDULE|1,522.00 PEMBINA COUNTY MEDICAL CENTER|PC3100080|PC SURGI WRAP MESH 120X200MM|MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT [0278]|C1781||PC STANDARD FEE SCHEDULE|907.00 PEMBINA COUNTY MEDICAL CENTER|PC3100086|PC METACARPOPHALANGEAL JT IM|MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT [0278]|L8630||PC STANDARD FEE SCHEDULE|742.00 PEMBINA COUNTY MEDICAL CENTER|PC3100083|PC METATARSAL JOINT IMPLANT|MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT [0278]|L8641||PC STANDARD FEE SCHEDULE|784.00 PEMBINA COUNTY MEDICAL CENTER|PC3100084|PC HALLUX IMPLANT|MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT [0278]|L8642||PC STANDARD FEE SCHEDULE|514.00 PEMBINA COUNTY MEDICAL CENTER|PC3100085|PC INTERPHALANGEAL JT SPACER|MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER IMPLANT [0278]|L8658||PC STANDARD FEE SCHEDULE|811.00 PEMBINA COUNTY MEDICAL CENTER|PC3600037|PC NH CABLE TV|MEDICAL/SURGICAL SUPPLIES AND DEVICES - OTHER SUPPLIES/DEVICES [0279]|||PC STANDARD FEE SCHEDULE|5.00 PEMBINA COUNTY MEDICAL CENTER|PC3310895|PC CYANOCOBALAMIN 1000MCG|NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS [0343]|A9546||PC STANDARD FEE SCHEDULE|5.00 PEMBINA COUNTY MEDICAL CENTER|PC3310952|PC LOCAL ANESTHESIA|ANESTHESIA - GENERAL CLASSIFICATION [0370]|||PC STANDARD FEE SCHEDULE|13.00 PEMBINA COUNTY MEDICAL CENTER|PC3319999|PC GASTROVIEW|PHARMACY - DRUGS INCIDENT TO RADIOLOGY [0255]|A9698||PC STANDARD FEE SCHEDULE|14.00 PEMBINA COUNTY MEDICAL CENTER|PC3330001|PC BIER BLOCK|ANESTHESIA - GENERAL CLASSIFICATION [0370]|||PC STANDARD FEE SCHEDULE|154.00 PEMBINA COUNTY MEDICAL CENTER|PC3330003|PC REGIONAL ANES ADDL 15MIN|ANESTHESIA - GENERAL CLASSIFICATION [0370]|||PC STANDARD FEE SCHEDULE|61.00 PEMBINA COUNTY MEDICAL CENTER|PC3330005|PC CRNA SERVICES 1ST HR|PROFESSIONAL FEES - ANESTHESIOLOGIST (CRNA) [0964]|||PC STANDARD FEE SCHEDULE|1,216.00 PEMBINA COUNTY MEDICAL CENTER|PC3330006|PC CRNA SERVICES EA ADDL HR|PROFESSIONAL FEES - ANESTHESIOLOGIST (CRNA) [0964]|||PC STANDARD FEE SCHEDULE|123.00 PEMBINA COUNTY MEDICAL CENTER|PC3330007|PC ANESTHESIA,GEN 1ST HR|ANESTHESIA - GENERAL CLASSIFICATION [0370]|||PC STANDARD FEE SCHEDULE|239.00 PEMBINA COUNTY MEDICAL CENTER|PC3330008|PC ANESTHESIA,ADDL 15 MIN|ANESTHESIA - GENERAL CLASSIFICATION [0370]|||PC STANDARD FEE SCHEDULE|61.00 PEMBINA COUNTY MEDICAL CENTER|PC3330012|PC REGIONAL ANES 1ST HR|ANESTHESIA - GENERAL CLASSIFICATION [0370]|||PC STANDARD FEE SCHEDULE|28.00 PEMBINA COUNTY MEDICAL CENTER|PC3110007|PC TREATMENT ROOM|SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM [0761]|||PC STANDARD FEE SCHEDULE|222.00 PEMBINA COUNTY MEDICAL CENTER|PC3130015|PC ARTERIAL COLLECTION|OTHER DIAGNOSTIC SERVICES - GENERAL CLASSIFICATION [0920]|36600||PC STANDARD FEE SCHEDULE|46.00 PEMBINA COUNTY MEDICAL CENTER|PC3130148|PC MISC TRANSFUSION MED PROC|ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - GENERAL CLASSIFICATION [0390]|86999||PC STANDARD FEE SCHEDULE|65.00 PEMBINA COUNTY MEDICAL CENTER|J7325.01|PR SYNVISC PER 1MG|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|J7325||PC STANDARD FEE SCHEDULE|72.00 PEMBINA COUNTY MEDICAL CENTER|90620|MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90620||PC STANDARD FEE SCHEDULE|216.75 PEMBINA COUNTY MEDICAL CENTER|PC3080006|PC LEVEL 3.5 SURGERY|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|||PC STANDARD FEE SCHEDULE|4,571.00 PEMBINA COUNTY MEDICAL CENTER|PC3140108|PC CYTOLOGY NON-GYN|LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION [0310]|88108||PC STANDARD FEE SCHEDULE|156.00 PEMBINA COUNTY MEDICAL CENTER|90685|IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90685||PC STANDARD FEE SCHEDULE|39.00 PEMBINA COUNTY MEDICAL CENTER|PC3120451|pC SHORT CAM BOOT|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|||PC STANDARD FEE SCHEDULE|149.00 PEMBINA COUNTY MEDICAL CENTER|PC3110011|PC TREATMENT ROOM/NON ER NURSE VISIT|SPECIALTY ROOM - TREATMENT/OBSERVATION ROOM - TREATMENT ROOM [0761]|||PC STANDARD FEE SCHEDULE|47.00 PEMBINA COUNTY MEDICAL CENTER|PC3138175|PC CYSTOPATHY W SCREENING|LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION [0310]|88175||PC STANDARD FEE SCHEDULE|179.00 PEMBINA COUNTY MEDICAL CENTER|PC3138313|PC SPECIAL STAIN GROUP II|LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION [0310]|88313||PC STANDARD FEE SCHEDULE|172.00 PEMBINA COUNTY MEDICAL CENTER|PC3330030|PC EPIDURAL STEROID INJECTION-CRNA|PROFESSIONAL FEES - ANESTHESIOLOGIST (CRNA) [0964]|00300||PC STANDARD FEE SCHEDULE|466.00 PEMBINA COUNTY MEDICAL CENTER|90688|IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE|PHARMACY - EXTENSION OF 025X - DRUGS REQUIRING DETAILED CODING (A) [0636]|90688||PC STANDARD FEE SCHEDULE|39.00 PEMBINA COUNTY MEDICAL CENTER|PC86003|PC IGE,SINGLE ALLERGEN,EACH|LABORATORY - IMMUNOLOGY [0302]|86003||PC STANDARD FEE SCHEDULE|136.00 PEMBINA COUNTY MEDICAL CENTER|PC80346|PC BENZODIAZEPINES;1-12|LABORATORY - CHEMISTRY [0301]|80346|90|PC STANDARD FEE SCHEDULE|209.00 PEMBINA COUNTY MEDICAL CENTER|PC80361|PC OPIATES,1 OR MORE|LABORATORY - CHEMISTRY [0301]|80361|90|PC STANDARD FEE SCHEDULE|220.00 PEMBINA COUNTY MEDICAL CENTER|PC87086|PC URINE CULTURE,QUANTITATION|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87086|90|PC STANDARD FEE SCHEDULE|48.00 PEMBINA COUNTY MEDICAL CENTER|PC87088|PC URINE CULTURE,PRESUMP ID|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87088||PC STANDARD FEE SCHEDULE|37.00 PEMBINA COUNTY MEDICAL CENTER|3430031|HC NUC MEBROFENIN|NUCLEAR MEDICINE - DIAGNOSTIC RADIOPHARMACEUTICALS [0343]|A9537||PC STANDARD FEE SCHEDULE|112.00 PEMBINA COUNTY MEDICAL CENTER|3910010|HC BLOOD ADMIN 0-2 HRS|ADMINISTRATION, PROCESSING, AND STORAGE FOR BLOOD AND BLOOD COMPONENTS - ADMINISTRATION (E.G., TRANS [0391]|36430||PC STANDARD FEE SCHEDULE|504.00 PEMBINA COUNTY MEDICAL CENTER|PC87624|PC HPV HIGH-RISK TYPES|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87624|90|PC STANDARD FEE SCHEDULE|70.00 PEMBINA COUNTY MEDICAL CENTER|PC3120070|PC CRUTCHES|MEDICAL/SURGICAL SUPPLIES AND DEVICES - GENERAL CLASSIFICATION [0270]|PC3120070||PC STANDARD FEE SCHEDULE|26.00 PEMBINA COUNTY MEDICAL CENTER|PC3130827|PC ANTI-XA HEPARIN ASSAY|LABORATORY - GENERAL CLASSIFICATION [0300]|85520||PC STANDARD FEE SCHEDULE|38.00 PEMBINA COUNTY MEDICAL CENTER|4902677|HC CORRECT MALROTATION OF BOWEL|OPERATING ROOM SERVICES - GENERAL CLASSIFICATION [0360]|44055||PC STANDARD FEE SCHEDULE|1,426.00 PEMBINA COUNTY MEDICAL CENTER|J3490.46|PR CLINDAMYCIN 600MG/4 ML INJ|PHARMACY - GENERAL CLASSIFICATION [0250]|J3490||PC STANDARD FEE SCHEDULE|25.00 PEMBINA COUNTY MEDICAL CENTER|PC3130542|MAYO KIDNEY STONE ANALYSIS|LABORATORY - CHEMISTRY [0301]|82365|90|PC STANDARD FEE SCHEDULE|164.00 PEMBINA COUNTY MEDICAL CENTER|PC3130543|MAYO 25-HYDROXYVITAMIN D2/D3|LABORATORY - CHEMISTRY [0301]|82306|90|PC STANDARD FEE SCHEDULE|299.00 PEMBINA COUNTY MEDICAL CENTER|PC3130545|MAYO INSULIN LIKE GROWTH FACTOR 1 S|LABORATORY - CHEMISTRY [0301]|84305||PC STANDARD FEE SCHEDULE|283.00 PEMBINA COUNTY MEDICAL CENTER|PC3130831|CALCULUS ASSAY,INFRARED SPECTR|LABORATORY - GENERAL CLASSIFICATION [0300]|82365||PC STANDARD FEE SCHEDULE|156.00 PEMBINA COUNTY MEDICAL CENTER|PC3130832|ALPHA-1 ANTI PHENO|LABORATORY - GENERAL CLASSIFICATION [0300]|82104||PC STANDARD FEE SCHEDULE|144.00 PEMBINA COUNTY MEDICAL CENTER|PC3130833|EBV,CAPSID|LABORATORY - GENERAL CLASSIFICATION [0300]|86665||PC STANDARD FEE SCHEDULE|163.00 PEMBINA COUNTY MEDICAL CENTER|PC3130834|DHEA|LABORATORY - GENERAL CLASSIFICATION [0300]|82626|90|PC STANDARD FEE SCHEDULE|322.00 PEMBINA COUNTY MEDICAL CENTER|PC3130835|LEVITIRACETAM|LABORATORY - GENERAL CLASSIFICATION [0300]|80177|90|PC STANDARD FEE SCHEDULE|173.00 PEMBINA COUNTY MEDICAL CENTER|PC3130836|CYTO/MOLECULAR REPORT|LABORATORY - GENERAL CLASSIFICATION [0300]|88291||PC STANDARD FEE SCHEDULE|1,157.00 PEMBINA COUNTY MEDICAL CENTER|PC3130837|TISSUE CULTURE SKIN/BIOPSY|LABORATORY - GENERAL CLASSIFICATION [0300]|88233||PC STANDARD FEE SCHEDULE|159.00 PEMBINA COUNTY MEDICAL CENTER|PC3130838|CHROMOSOME,BLOOD|LABORATORY - GENERAL CLASSIFICATION [0300]|88262||PC STANDARD FEE SCHEDULE|159.00 PEMBINA COUNTY MEDICAL CENTER|PC3130839|CANNABINOIDS,NATURAL|LABORATORY - GENERAL CLASSIFICATION [0300]|80349|90|PC STANDARD FEE SCHEDULE|212.00 PEMBINA COUNTY MEDICAL CENTER|PC3130437|OXCARBAZEPINE LEVEL|LABORATORY - CHEMISTRY [0301]|80183|90|PC STANDARD FEE SCHEDULE|217.00 PEMBINA COUNTY MEDICAL CENTER|PC3130228|TISSUE TRANSGL IGA|LABORATORY - CHEMISTRY [0301]|83516|90|PC STANDARD FEE SCHEDULE|238.00 PEMBINA COUNTY MEDICAL CENTER|PC3130438|HSV TYPE 1 AB,IGG|LABORATORY - IMMUNOLOGY [0302]|86695|90|PC STANDARD FEE SCHEDULE|98.00 PEMBINA COUNTY MEDICAL CENTER|PC3130439|HSV TYPE 2 AB,IGG|LABORATORY - IMMUNOLOGY [0302]|86696|90|PC STANDARD FEE SCHEDULE|98.00 PEMBINA COUNTY MEDICAL CENTER|PC3130798|PLAMOTRIGINE MAYO|LABORATORY - CHEMISTRY [0301]|80175|90|PC STANDARD FEE SCHEDULE|177.00 PEMBINA COUNTY MEDICAL CENTER|PC3130546|QUANTIFERRON (MAYO)|LABORATORY - CHEMISTRY [0301]|86480|90|PC STANDARD FEE SCHEDULE|186.00 PEMBINA COUNTY MEDICAL CENTER|PC3130547|HCV RNA (MAYO)|LABORATORY - CHEMISTRY [0301]|87552|90|PC STANDARD FEE SCHEDULE|753.00 PEMBINA COUNTY MEDICAL CENTER|PC3130548|THIAMIN VIT B1 (MAYO)|LABORATORY - CHEMISTRY [0301]|84425|90|PC STANDARD FEE SCHEDULE|230.00 PEMBINA COUNTY MEDICAL CENTER|PC3130549|CONFIRMED DRUG ABUSE PANEL 9|LABORATORY - CHEMISTRY [0301]|80301|90|PC STANDARD FEE SCHEDULE|162.00 PEMBINA COUNTY MEDICAL CENTER|PC3130550|JC POLYOMA VIRUS DAN,QN PC|LABORATORY - CHEMISTRY [0301]|87799|90|PC STANDARD FEE SCHEDULE|383.00 PEMBINA COUNTY MEDICAL CENTER|PC3130551|TESTOSTERONE BIOAVAIL (MAYO)|LABORATORY - CHEMISTRY [0301]|84999|90|PC STANDARD FEE SCHEDULE|73.00 PEMBINA COUNTY MEDICAL CENTER|PC3130552|DRUG SCRN AMPHETAMINES 1/2 80324|LABORATORY - CHEMISTRY [0301]|80324|90|PC STANDARD FEE SCHEDULE|213.00 PEMBINA COUNTY MEDICAL CENTER|PC3130553|METHYLENEDIOXYAMPHETAMINES|LABORATORY - CHEMISTRY [0301]|80359|90|PC STANDARD FEE SCHEDULE|213.00 PEMBINA COUNTY MEDICAL CENTER|PC3130554|PC VIRAL SEROLOGY|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87389|90|PC STANDARD FEE SCHEDULE|237.00 PEMBINA COUNTY MEDICAL CENTER|PC87150|PC CULTURE,TYPING,ID BY DNA/RNA AMP PROBE EA ORGANISM|LABORATORY - GENERAL CLASSIFICATION [0300]|87150|90|PC STANDARD FEE SCHEDULE|248.00 PEMBINA COUNTY MEDICAL CENTER|PC3130555|PC METHADONE|LABORATORY - GENERAL CLASSIFICATION [0300]|80358|90|PC STANDARD FEE SCHEDULE|212.00 PEMBINA COUNTY MEDICAL CENTER|PC3130556|PC CALCR,GENE MUTATION|LABORATORY - GENERAL CLASSIFICATION [0300]|81219|90|PC STANDARD FEE SCHEDULE|790.00 PEMBINA COUNTY MEDICAL CENTER|PC3130557|PC JAK2 GENE ANALYSIS|LABORATORY - GENERAL CLASSIFICATION [0300]|81270|90|PC STANDARD FEE SCHEDULE|675.00 PEMBINA COUNTY MEDICAL CENTER|PC3130558|PC HLA II TYPING LOCUS LR|LABORATORY - GENERAL CLASSIFICATION [0300]|81376|90|PC STANDARD FEE SCHEDULE|252.00 PEMBINA COUNTY MEDICAL CENTER|PC3130559|PC MPL EXON 10 MUT PATH|LABORATORY - GENERAL CLASSIFICATION [0300]|81403|90|PC STANDARD FEE SCHEDULE|729.00 PEMBINA COUNTY MEDICAL CENTER|PC3130560|PC FETAL CGEN ABNOR 4 AN|LABORATORY - GENERAL CLASSIFICATION [0300]|81555|90|PC STANDARD FEE SCHEDULE|459.00 PEMBINA COUNTY MEDICAL CENTER|PC3130561|PC CHROMIUM|LABORATORY - GENERAL CLASSIFICATION [0300]|82495|90|PC STANDARD FEE SCHEDULE|255.00 PEMBINA COUNTY MEDICAL CENTER|PC3130562|PC VITAMIN D 1,25|LABORATORY - GENERAL CLASSIFICATION [0300]|82652|90|PC STANDARD FEE SCHEDULE|352.00 PEMBINA COUNTY MEDICAL CENTER|PC3130563|PC FETAL FIBRONECTIN|LABORATORY - GENERAL CLASSIFICATION [0300]|82731|90|PC STANDARD FEE SCHEDULE|178.00 PEMBINA COUNTY MEDICAL CENTER|PC3130564|PC CARINOEMBRYONIC ANTIGEN|LABORATORY - GENERAL CLASSIFICATION [0300]|82738|90|PC STANDARD FEE SCHEDULE|92.00 PEMBINA COUNTY MEDICAL CENTER|PC3130565|PC HEAVY METAL SCREEN|LABORATORY - GENERAL CLASSIFICATION [0300]|83018|90|PC STANDARD FEE SCHEDULE|223.00 PEMBINA COUNTY MEDICAL CENTER|PC3130566|PC CALPROTECTIN|LABORATORY - GENERAL CLASSIFICATION [0300]|83993|90|PC STANDARD FEE SCHEDULE|270.00 PEMBINA COUNTY MEDICAL CENTER|PC3130567|PC SULFATE,URINE|LABORATORY - GENERAL CLASSIFICATION [0300]|84392|90|PC STANDARD FEE SCHEDULE|146.00 PEMBINA COUNTY MEDICAL CENTER|PC3130568|PC UREA NITROEN,U|LABORATORY - GENERAL CLASSIFICATION [0300]|84540|90|PC STANDARD FEE SCHEDULE|146.00 PEMBINA COUNTY MEDICAL CENTER|PC3130569|PC VON WILLEBRAND FAC AG,P|LABORATORY - GENERAL CLASSIFICATION [0300]|85246|90|PC STANDARD FEE SCHEDULE|456.00 PEMBINA COUNTY MEDICAL CENTER|PC3130570|PC VON WILLEBRAND FAC ACT|LABORATORY - GENERAL CLASSIFICATION [0300]|85397|90|PC STANDARD FEE SCHEDULE|456.00 PEMBINA COUNTY MEDICAL CENTER|PC3130571|PC HEXAGONAL PHASE CONFIRM|LABORATORY - GENERAL CLASSIFICATION [0300]|85598|90|PC STANDARD FEE SCHEDULE|105.00 PEMBINA COUNTY MEDICAL CENTER|PC3130572|PC COLD AGGLUTININ|LABORATORY - GENERAL CLASSIFICATION [0300]|86156|90|PC STANDARD FEE SCHEDULE|184.00 PEMBINA COUNTY MEDICAL CENTER|PC3130573|PC ASPERGILLUS FUMIGATUS IGG|LABORATORY - GENERAL CLASSIFICATION [0300]|86606|90|PC STANDARD FEE SCHEDULE|153.00 PEMBINA COUNTY MEDICAL CENTER|PC3130574|PC BLASTOMYCES AB|LABORATORY - GENERAL CLASSIFICATION [0300]|86612|90|PC STANDARD FEE SCHEDULE|242.00 PEMBINA COUNTY MEDICAL CENTER|PC3130575|PC COCCIDIOIDES AB,S|LABORATORY - GENERAL CLASSIFICATION [0300]|86635|90|PC STANDARD FEE SCHEDULE|70.00 PEMBINA COUNTY MEDICAL CENTER|PC3130576|PC EPSTEIN BARR VIRUS|LABORATORY - GENERAL CLASSIFICATION [0300]|86663|90|PC STANDARD FEE SCHEDULE|192.00 PEMBINA COUNTY MEDICAL CENTER|PC3130577|PC HISTOPLASMA AB,S|LABORATORY - GENERAL CLASSIFICATION [0300]|86698|90|PC STANDARD FEE SCHEDULE|78.00 PEMBINA COUNTY MEDICAL CENTER|PC3130578|PC HEPATITIS A TOTAL AB,S|LABORATORY - GENERAL CLASSIFICATION [0300]|86708|90|PC STANDARD FEE SCHEDULE|100.00 PEMBINA COUNTY MEDICAL CENTER|PC3130579|PC HC RSV,DFA|LABORATORY - GENERAL CLASSIFICATION [0300]|87280|90|PC STANDARD FEE SCHEDULE|134.00 PEMBINA COUNTY MEDICAL CENTER|PC3130580|PC ASPERGILLUS AG,S|LABORATORY - GENERAL CLASSIFICATION [0300]|87305|90|PC STANDARD FEE SCHEDULE|225.00 PEMBINA COUNTY MEDICAL CENTER|PC3130581|PC IAAD IA CLOST DIFF TOXIN|LABORATORY - GENERAL CLASSIFICATION [0300]|87324|90|PC STANDARD FEE SCHEDULE|134.00 PEMBINA COUNTY MEDICAL CENTER|PC3130582|PC LYME DISEASE PCR,B|LABORATORY - GENERAL CLASSIFICATION [0300]|87476|90|PC STANDARD FEE SCHEDULE|581.00 PEMBINA COUNTY MEDICAL CENTER|PC3130583|PC HEPATITIS C|LABORATORY - GENERAL CLASSIFICATION [0300]|87522|90|PC STANDARD FEE SCHEDULE|753.00 PEMBINA COUNTY MEDICAL CENTER|PC3130584|PC HSV PCR|LABORATORY - GENERAL CLASSIFICATION [0300]|87529|90|PC STANDARD FEE SCHEDULE|456.00 PEMBINA COUNTY MEDICAL CENTER|PC3130585|PC DETECT AGENT,RSV|LABORATORY - GENERAL CLASSIFICATION [0300]|87807|90|PC STANDARD FEE SCHEDULE|79.00 PEMBINA COUNTY MEDICAL CENTER|PC3130586|PC FLOW CYTOMETRY INTERP,2-8 MARKER|LABORATORY - GENERAL CLASSIFICATION [0300]|88187|90|PC STANDARD FEE SCHEDULE|122.00 PEMBINA COUNTY MEDICAL CENTER|PC3130587|PC CYTOGENETICS DNA PROBE|LABORATORY - GENERAL CLASSIFICATION [0300]|88271|90|PC STANDARD FEE SCHEDULE|75.00 PEMBINA COUNTY MEDICAL CENTER|PC3130588|PC INTERPHASES,100-300|LABORATORY - GENERAL CLASSIFICATION [0300]|88275|90|PC STANDARD FEE SCHEDULE|140.00 PEMBINA COUNTY MEDICAL CENTER|PC3130505|PC SUSCEPTIBILITY,BETA LACTAMASE|LABORATORY - GENERAL CLASSIFICATION [0300]|87185|90|PC STANDARD FEE SCHEDULE|27.00 PEMBINA COUNTY MEDICAL CENTER|90648.01|PR HIBEREX VACCINE|PHARMACY - GENERAL CLASSIFICATION [0250]|90648||PC STANDARD FEE SCHEDULE|18.00 PEMBINA COUNTY MEDICAL CENTER|PC3130271|PC UROVYSION FOR BLADDER|LABORATORY PATHOLOGICAL - CYTOLOGY [0311]|88120|90|PC STANDARD FEE SCHEDULE|1,102.00 PEMBINA COUNTY MEDICAL CENTER|PC3130273|PC CHLAMYDIA IGG|LABORATORY - CHEMISTRY [0301]|86631|90|PC STANDARD FEE SCHEDULE|52.00 PEMBINA COUNTY MEDICAL CENTER|PC3130274|PC CHLAMYDIA IGM|LABORATORY - CHEMISTRY [0301]|86632|90|PC STANDARD FEE SCHEDULE|52.00 PEMBINA COUNTY MEDICAL CENTER|PC3130276|PC ANDROSTENEDIONE SERUM|LABORATORY - CHEMISTRY [0301]|82157|90|PC STANDARD FEE SCHEDULE|359.00 PEMBINA COUNTY MEDICAL CENTER|PC3130277|PC MALARIA PCR W/PARASIT|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87798|90|PC STANDARD FEE SCHEDULE|396.00 PEMBINA COUNTY MEDICAL CENTER|PC87103|PC MICRO MOLD PATH|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87103|90|PC STANDARD FEE SCHEDULE|66.00 PEMBINA COUNTY MEDICAL CENTER|PC82671|PC ESTRADIOL|LABORATORY - CHEMISTRY [0301]|82671|90|PC STANDARD FEE SCHEDULE|335.00 PEMBINA COUNTY MEDICAL CENTER|PC87899|PC INFECT AGENT ANTIGEN|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87899|90|PC STANDARD FEE SCHEDULE|30.00 PEMBINA COUNTY MEDICAL CENTER|PC87015|PC SPEC INFECT AGENT|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87015|90|PC STANDARD FEE SCHEDULE|66.00 PEMBINA COUNTY MEDICAL CENTER|PC83088|PC HISTAMINE URINE|LABORATORY - CHEMISTRY [0301]|83088|90|PC STANDARD FEE SCHEDULE|159.00 PEMBINA COUNTY MEDICAL CENTER|PC86215|PC D-NASE B ANTIBODY|LABORATORY - CHEMISTRY [0301]|86215|90|PC STANDARD FEE SCHEDULE|156.00 PEMBINA COUNTY MEDICAL CENTER|PC81340|PC T-CELL|LABORATORY - CHEMISTRY [0301]|81340|90|PC STANDARD FEE SCHEDULE|574.00 PEMBINA COUNTY MEDICAL CENTER|PC81342|PC T-CELL ANTIGEN|LABORATORY - CHEMISTRY [0301]|81342|90|PC STANDARD FEE SCHEDULE|574.00 PEMBINA COUNTY MEDICAL CENTER|99151|MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99151||PC M/M HB CLINIC|233.00 PEMBINA COUNTY MEDICAL CENTER|99152|MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99152||PC M/M HB CLINIC|195.00 PEMBINA COUNTY MEDICAL CENTER|99153|MOD SED SAME PHYS/QHP EACH ADDL 15 MINS|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99153||PC M/M HB CLINIC|195.00 PEMBINA COUNTY MEDICAL CENTER|99155|MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99155||PC M/M HB CLINIC|233.00 PEMBINA COUNTY MEDICAL CENTER|99156|MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99156||PC M/M HB CLINIC|195.00 PEMBINA COUNTY MEDICAL CENTER|99157|MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS|PROFESSIONAL FEES - OUTPATIENT SERVICES [0982]|99157||PC M/M HB CLINIC|195.00 PEMBINA COUNTY MEDICAL CENTER|PC3130618|PC 17-HYDROXYPREGNENONONE,S|LABORATORY - CHEMISTRY [0301]|84143|90|PC STANDARD FEE SCHEDULE|162.00 PEMBINA COUNTY MEDICAL CENTER|PC3130619|PC HELICIBACTER PYLORI AG,F|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87338|90|PC STANDARD FEE SCHEDULE|291.00 PEMBINA COUNTY MEDICAL CENTER|PC3130620|PC HERPES AB SCREEN IGM,S|LABORATORY - CHEMISTRY [0301]|86694|90|PC STANDARD FEE SCHEDULE|132.00 PEMBINA COUNTY MEDICAL CENTER|PC3130621|PC FTL CGEN ABNOR FOUR ANA|LABORATORY - CHEMISTRY [0301]|81511|90|PC STANDARD FEE SCHEDULE|479.00 PEMBINA COUNTY MEDICAL CENTER|PC80329|PC DRUG SCREEN ANALGESICS 1 OR 2|LABORATORY - CHEMISTRY [0301]|80329|90|PC STANDARD FEE SCHEDULE|131.00 PEMBINA COUNTY MEDICAL CENTER|PC81256|PC HEMOCHROMATOSIS HPE|LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION [0310]|81256|90|PC STANDARD FEE SCHEDULE|263.00 PEMBINA COUNTY MEDICAL CENTER|PC82985|PC GLYCATED PROTEIN|LABORATORY - CHEMISTRY [0301]|82985|90|PC STANDARD FEE SCHEDULE|42.00 PEMBINA COUNTY MEDICAL CENTER|PC3130445|PC DRUG SCRN NON TLC DEVICES|LABORATORY - GENERAL CLASSIFICATION [0300]|80305||PC STANDARD FEE SCHEDULE|100.00 PEMBINA COUNTY MEDICAL CENTER|PC3130447|PC FLOW CYTOMETRY INTERP >16|LABORATORY PATHOLOGICAL - CYTOLOGY [0311]|88189|90|PC STANDARD FEE SCHEDULE|389.00 PEMBINA COUNTY MEDICAL CENTER|PC3130449|PC BETA LACTAMASE|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87185|90|PC STANDARD FEE SCHEDULE|31.00 PEMBINA COUNTY MEDICAL CENTER|PC3130448|PC SALICYLATE/ACETAMINOPHENE|LABORATORY - CHEMISTRY [0301]|80307|90|PC STANDARD FEE SCHEDULE|131.00 PEMBINA COUNTY MEDICAL CENTER|3200360|HC XRAY ABDOMEN 1 VIEW|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|74018||PC STANDARD FEE SCHEDULE|66.00 PEMBINA COUNTY MEDICAL CENTER|3200361|HC XRAY ABDOMEN 2 VIEWS|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|74019||PC STANDARD FEE SCHEDULE|111.00 PEMBINA COUNTY MEDICAL CENTER|3200362|HC XRAY ABDOMEN 3+ VIEWS|RADIOLOGY - DIAGNOSTIC - GENERAL CLASSIFICATION [0320]|74021||PC STANDARD FEE SCHEDULE|116.00 PEMBINA COUNTY MEDICAL CENTER|3240020|HC XRAY CHEST 1 VIEW|RADIOLOGY - DIAGNOSTIC - CHEST X-RAY [0324]|71045||PC STANDARD FEE SCHEDULE|60.00 PEMBINA COUNTY MEDICAL CENTER|3240021|HC XRAY CHEST 2 VIEWS|RADIOLOGY - DIAGNOSTIC - CHEST X-RAY [0324]|71046||PC STANDARD FEE SCHEDULE|81.00 PEMBINA COUNTY MEDICAL CENTER|3240022|HC XRAY CHEST 3 VIEWS|RADIOLOGY - DIAGNOSTIC - CHEST X-RAY [0324]|71047||PC STANDARD FEE SCHEDULE|101.00 PEMBINA COUNTY MEDICAL CENTER|3240023|HC XRAY CHEST 4+ VIEWS|RADIOLOGY - DIAGNOSTIC - CHEST X-RAY [0324]|71048||PC STANDARD FEE SCHEDULE|130.00 PEMBINA COUNTY MEDICAL CENTER|4300045|HC THERAPEUTIC INTERVENTION-COGNITIVE FUNCTION|OCCUPATIONAL THERAPY - GENERAL CLASSIFICATION [0430]|97127||PC STANDARD FEE SCHEDULE|61.00 PEMBINA COUNTY MEDICAL CENTER|4010016|HC MAMMO OF BOTH BREASTS|OTHER IMAGING SERVICES - DIAGNOSTIC MAMMOGRAPHY [0401]|77066||PC STANDARD FEE SCHEDULE|419.00 PEMBINA COUNTY MEDICAL CENTER|4010015|HC MAMMO OF ONE BREAST|OTHER IMAGING SERVICES - DIAGNOSTIC MAMMOGRAPHY [0401]|77065||PC STANDARD FEE SCHEDULE|336.00 PEMBINA COUNTY MEDICAL CENTER|4030015|HC MAMMO OF BOTH BREASTS|OTHER IMAGING SERVICES - SCREENING MAMMOGRAPHY [0403]|77067||PC STANDARD FEE SCHEDULE|357.00 PEMBINA COUNTY MEDICAL CENTER|PC3130840|PC DRUG SCREEN QUANT ANA|LABORATORY - CHEMISTRY [0301]|80327|90|PC STANDARD FEE SCHEDULE|140.00 PEMBINA COUNTY MEDICAL CENTER|PC3130841|PC HEMOCHROMATOSIS,HFE|LABORATORY - GENERAL CLASSIFICATION [0300]|81256|90|PC STANDARD FEE SCHEDULE|379.00 PEMBINA COUNTY MEDICAL CENTER|PC3130842|PC MOPATH PROCEDURE,LEVEL|LABORATORY - GENERAL CLASSIFICATION [0300]|81405|90|PC STANDARD FEE SCHEDULE|1,030.00 PEMBINA COUNTY MEDICAL CENTER|PC3130843|PC MOPATH PROC LEVEL|LABORATORY - GENERAL CLASSIFICATION [0300]|81406|90|PC STANDARD FEE SCHEDULE|1,030.00 PEMBINA COUNTY MEDICAL CENTER|PC3130844|PC CST3R EXON 14/17|LABORATORY - GENERAL CLASSIFICATION [0300]|81479|90|PC STANDARD FEE SCHEDULE|1,890.00 PEMBINA COUNTY MEDICAL CENTER|PC3130845|PC MATERNI T21|LABORATORY - GENERAL CLASSIFICATION [0300]|81479|90|PC STANDARD FEE SCHEDULE|100.00 PEMBINA COUNTY MEDICAL CENTER|PC3130846|PC GC-MS,QUANTITATIVE|LABORATORY - GENERAL CLASSIFICATION [0300]|82542|90|PC STANDARD FEE SCHEDULE|221.00 PEMBINA COUNTY MEDICAL CENTER|PC3130847|PC PANCREATIC ELASTASE,FECAL|LABORATORY - GENERAL CLASSIFICATION [0300]|82656|90|PC STANDARD FEE SCHEDULE|259.00 PEMBINA COUNTY MEDICAL CENTER|PC3130848|PC G-6-PD,QN,RBC|LABORATORY - GENERAL CLASSIFICATION [0300]|82955|90|PC STANDARD FEE SCHEDULE|122.00 PEMBINA COUNTY MEDICAL CENTER|PC3130849|PC H PYLORI,UREASE|LABORATORY - GENERAL CLASSIFICATION [0300]|83013|90|PC STANDARD FEE SCHEDULE|391.00 PEMBINA COUNTY MEDICAL CENTER|PC3130850|PC H PYLORI,UREASE|LABORATORY - GENERAL CLASSIFICATION [0300]|83014|90|PC STANDARD FEE SCHEDULE|82.00 PEMBINA COUNTY MEDICAL CENTER|PC3130851|PC 17-HYDROXYPROGESTERONE|LABORATORY - CHEMISTRY [0301]|83498|90|PC STANDARD FEE SCHEDULE|158.00 PEMBINA COUNTY MEDICAL CENTER|PC3130852|PC PREALBUMIN|LABORATORY - GENERAL CLASSIFICATION [0300]|84134|90|PC STANDARD FEE SCHEDULE|65.00 PEMBINA COUNTY MEDICAL CENTER|PC3130853|PC SEX HORMONE BINDING GLOB|LABORATORY - GENERAL CLASSIFICATION [0300]|84270|90|PC STANDARD FEE SCHEDULE|126.00 PEMBINA COUNTY MEDICAL CENTER|PC3130854|PC VON WILLEBRAND FACTOR MULTI|LABORATORY - GENERAL CLASSIFICATION [0300]|85247|90|PC STANDARD FEE SCHEDULE|251.00 PEMBINA COUNTY MEDICAL CENTER|PC3130855|PC ANA TITER|LABORATORY - GENERAL CLASSIFICATION [0300]|86039|90|PC STANDARD FEE SCHEDULE|90.00 PEMBINA COUNTY MEDICAL CENTER|PC3130856|PC CYTOMEGALOVIRUS|LABORATORY - GENERAL CLASSIFICATION [0300]|86645|90|PC STANDARD FEE SCHEDULE|92.00 PEMBINA COUNTY MEDICAL CENTER|PC3130857|PC ANTIBODY,PROTOZOA|LABORATORY - GENERAL CLASSIFICATION [0300]|86753|90|PC STANDARD FEE SCHEDULE|65.00 PEMBINA COUNTY MEDICAL CENTER|PC3130858|PC SYPHILLUS|LABORATORY - GENERAL CLASSIFICATION [0300]|86780|90|PC STANDARD FEE SCHEDULE|77.00 PEMBINA COUNTY MEDICAL CENTER|PC3130859|PC SUSCEPTIBILITY DISK PERP|LABORATORY - GENERAL CLASSIFICATION [0300]|87184|90|PC STANDARD FEE SCHEDULE|41.00 PEMBINA COUNTY MEDICAL CENTER|PC3130860|PC SMEAR INCLUSION BODIES/PAR|LABORATORY - GENERAL CLASSIFICATION [0300]|87207|90|PC STANDARD FEE SCHEDULE|36.00 PEMBINA COUNTY MEDICAL CENTER|PC3130861|PC SMEAR,COMPLEX STAIN OVA/PARA|LABORATORY - GENERAL CLASSIFICATION [0300]|87209|90|PC STANDARD FEE SCHEDULE|105.00 PEMBINA COUNTY MEDICAL CENTER|PC3130862|PC CANDIDA SP DIRECT PROBE|LABORATORY - GENERAL CLASSIFICATION [0300]|87480|90|PC STANDARD FEE SCHEDULE|117.00 PEMBINA COUNTY MEDICAL CENTER|PC3130863|PC INF AGENT DET ACID|LABORATORY - GENERAL CLASSIFICATION [0300]|87493|90|PC STANDARD FEE SCHEDULE|204.00 PEMBINA COUNTY MEDICAL CENTER|PC3130864|PC G VAGINALIS DIRECT PROBE|LABORATORY - GENERAL CLASSIFICATION [0300]|87510|90|PC STANDARD FEE SCHEDULE|117.00 PEMBINA COUNTY MEDICAL CENTER|PC3130865|PC T VAGINALIS DIRECT PROBE|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87660|90|PC STANDARD FEE SCHEDULE|117.00 PEMBINA COUNTY MEDICAL CENTER|PC3130866|PC INFLUENZA|LABORATORY - GENERAL CLASSIFICATION [0300]|87804||PC STANDARD FEE SCHEDULE|70.00 PEMBINA COUNTY MEDICAL CENTER|PC3130867|PC CYTOPATHOLOGY TL NON-GYN|LABORATORY - GENERAL CLASSIFICATION [0300]|88112|90|PC STANDARD FEE SCHEDULE|123.00 PEMBINA COUNTY MEDICAL CENTER|PC3130868|PC INFLUENZA|LABORATORY - GENERAL CLASSIFICATION [0300]|87804|59|PC STANDARD FEE SCHEDULE|70.00 PEMBINA COUNTY MEDICAL CENTER|PC3136580|PC TUBERCULIN SKIN TEST|LABORATORY - IMMUNOLOGY [0302]|86580||PC STANDARD FEE SCHEDULE|19.00 PEMBINA COUNTY MEDICAL CENTER|PC3138069|PC RENAL FUNCTION PANEL|LABORATORY - CHEMISTRY [0301]|80069|90|PC STANDARD FEE SCHEDULE|53.00 PEMBINA COUNTY MEDICAL CENTER|PC3131206|PC BCR/ABL P210|LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION [0310]|81206|90|PC STANDARD FEE SCHEDULE|1,011.00 PEMBINA COUNTY MEDICAL CENTER|PC3131207|PC BCR/ABL P190|LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION [0310]|81207|90|PC STANDARD FEE SCHEDULE|911.00 PEMBINA COUNTY MEDICAL CENTER|PC3131220|PC CYSTIC FIBROSIS MUTATION PANEL|LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION [0310]|81220|90|PC STANDARD FEE SCHEDULE|345.00 PEMBINA COUNTY MEDICAL CENTER|PC3131241|PC FACTOR V LEIDEN|LABORATORY PATHOLOGICAL - GENERAL CLASSIFICATION [0310]|81241|90|PC STANDARD FEE SCHEDULE|206.00 PEMBINA COUNTY MEDICAL CENTER|PC3132657|PC TPMT ACTIVITY PROFILE,RB|LABORATORY - CHEMISTRY [0301]|82657|90|PC STANDARD FEE SCHEDULE|754.00 PEMBINA COUNTY MEDICAL CENTER|PC3136790|PC HANTAVIRUS ANTIBODY IGG|LABORATORY - IMMUNOLOGY [0302]|86790|90|PC STANDARD FEE SCHEDULE|275.00 PEMBINA COUNTY MEDICAL CENTER|PC3139000|PC MISC COLLECTION|LABORATORY - GENERAL CLASSIFICATION [0300]|99000||PC STANDARD FEE SCHEDULE|20.00 PEMBINA COUNTY MEDICAL CENTER|PC3130875|PC HEPATITIS B VIRUS,QUANT|LABORATORY - BACTERIOLOGY AND MICROBIOLOGY [0306]|87517|90|PC STANDARD FEE SCHEDULE|246.00