HCPCS Code - Charge Code Item Description General Ledger Key Medicare Medicaid Charges Revenue Code Activity Date - 49683105 CT scan; head; w/out contrast 3 70450 70450 500.00 0351 1/1/2013 - 49683106 CT scan; head; with contrast 3 70460 70460 675.00 0351 1/1/2013 - Under APCs - the patient is responsible for paying the coinsurance amount based upon ________ of the national median charge for the services rendered.

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HCPCS Code - Charge Code Item Description General Ledger Key Medicare Medicaid Charges Revenue Code Activity Date - 49683105 CT scan; head; w/out contrast 3 70450 70450 500.00 0351 1/1/2013 - 49683106 CT scan; head; with contrast 3 70460 70460 675.00 0351 1/1/2013 - Under APCs - the patient is responsible for paying the coinsurance amount based upon ________ of the national median charge for the services rendered.